Diagnosis of central nervous system lymphoma via cerebrospinal fluid cytology: a case report

Abstract

Background Primary central nervous system lymphoma (PCNSL) is the most prevalent brain, spinal cord, eyes, and leptomeningeal lymphoma. It is often misdiagnosed due to an unspecific presentation or unavailable biopsy and results in a poor prognosis. Although the craniocerebral imaging examination of PCNSL has some characteristics, it is limited, and atypical cases are especially difficult to identify with intracranial tumours and other diseases. The biopsy, as the gold standard for PCNSL diagnosis, is not eligible for all patients suspected of having PCNSL. Case presentation This report documents a woman who presented with a three-month history of numbness and weakness in the right leg. She was treated with drugs at a local hospital for one month. She developed demyelination lesions and her symptoms were aggravated. The patient was admitted to the Department of Nerve Infection and Immunology at Tiantan Hospital. Head magnetic resonance imaging (MRI) enhanced scanning indicated significant inflammatory demyelinating disease, and lymphoma was not excluded. CSF revealed a high protein level and CSF cytology detected abnormal cells, PCNSL was eventually presumed according to positive CSF cytology and cytological detection of the cerebrospinal fluid flow. Conclusions PCNSL is a highly invasive tumour. With the development of technologies such as cerebrospinal fluid cytology and flow cytology, CSF analysis has become one of the definite diagnosis methods, and the tumour cell finding in CSF is the only reliable basis for diagnosis. Flow cytometric analysis and gene rearrangement testing also provide objective evidence.

A Case of Primary Leptomeningeal Lymphoma Presenting with Hydrocephalus Characterized by Disproportionately Large Fourth Ventricle

“…For the definitive diagnosis of PLML, histological confirmation is essential and tumor cell findings in CSF are the most reliable basis. 5) However, positive CSF cytology is dependent on the proportion of malignant cells in the sample and the integrity of the sample, and negative CSF is not uncommon. 4 , 10 , 13 , 14) Further analysis by flow cytometry for monoclonal population or by gene rearrangement is proposed to yield higher sensitivity.…”

“… 4 , 10 , 13 , 14) Further analysis by flow cytometry for monoclonal population or by gene rearrangement is proposed to yield higher sensitivity. 5 , 13 , 15) Besides CSF cytology, CSF profile including leukocyte, protein, and glucose is reported to be always abnormal in patients with PLML 4) and could be an important suggestive finding. In our case, it should be noted that the initial CSF profile was almost normal, misleading into ruling out malignancy.…”

“… 2 , 3) While leptomeningeal dissemination can be seen as a late manifestation of systemic lymphoma or synchronously with primary central nerve system malignant lymphoma (PCNSL), lymphoma isolated to the leptomeninges, which is categorized as primary leptomeningeal malignant lymphoma (PLML), is exceedingly rare. 4 , 5) The clinical presentation of PLML varies depending mainly on the locations involved by lymphomatous lesions, and hydrocephalus can also be the trigger for disclosing underlying intracranial malignant lymphoma. 4 , 6 – 10) As for diagnostic workup for PLML, recognizing suggestive findings on magnetic resonance imaging (MRI), such as abnormal enhancement on the surface of brain or ventricular wall, is the key, and definitive diagnosis requires histopathological confirmation via cerebrospinal fluid (CSF) or biopsy.…”

Case Review: Primary T-cell CNS Lymphoma in a Pediatric Immunocompetent Patient

“…On imaging, there is no definitive pattern for diagnosis and reactive processes cannot be ruled out. T cell PCNSL could resemble an abscess, demyelinating lesion, metastatic lesion, infection or inflammatory reaction, thus making it difficult to diagnose based on imaging solely [26]. In the large retrospective study mentioned previously where 45 patients with T cell PCNSL were described, 26 (58%) of them had cerebral hemisphere involvement and 16 (36%) patients had deeper parenchymal involvement [23].…”

HIV/AIDS Associated Lymphoma: Review

“… 6 , 22 The most common symptoms of PCNSL are changes in mental state and intracranial pressure symptoms like headache, nausea, vomiting, papilledema, and local compression symptoms such as epilepsy, memory loss, unstable gait, visual impairment, blurred speech. 32 …”