Primary CNS T-Cell Lymphoma: A Case Report on a Solitary Cerebellar Lesion and Review of Current Relevant Literature

Aden McLaughlin, Sharon Gabizon

Department of Neurosurgery, Gold Coast Hospital, Gold Coast, Australia.

DOI: 10.4236/ojmn.2013.32004                

Abstract

Primary central nervous system lymphoma of T-cell lineage (PCNSTL) is an extremely rare entity, with relatively few cases reported in the literature. Presented here is a case of a 44-year-old, HIV negative woman found to have a solitary cerebellar lesion following presentation to the Emergency Department with a fall. The lesion responded to emergent dexamethasone and was followed with serial MRI imaging, which continued to show lesion regression. The lesion was shown to have recurred on MRI 14 months post-presentation and found to be T-cell lymphoma following immunophenotyping and TCR gene rearrangement studies of tissue specimen obtained via excisional biopsy.

Keywords

Primary CNS; Lymphoma; Methotrexate; T-Cell

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. Schabet, “Epidemiology of Primary CNS Lymphoma,” Journal of Neuro-Oncology, Vol. 43, No. 3, 1999, pp. 199-201. doi:10.1023/A:1006290032052
[2]	CBTRUS, “Statistical Report: Primary Brain Tumors in the United States, 1992-1997,” Central Brain Tumor Registry of the United States, Chicago, 2000.
[3]	T. N. Shenkier, J. Y. Blay, B. P. O’Neill, et al., “Primary CNS Lymphoma of T-Cell Origin: A Descriptive Analysis from the International Primary CNS Lymphoma Collaborative Group,” Journal of Clinical Oncology, Vol. 23, No. 10, 2005, pp. 2233-2239. doi:10.1200/JCO.2005.07.109
[4]	M. S. Dulai, C. Y. Park, W. D. Howell, et al., “CNS T-Cell Lymphoma: An Under Recognised Entity?” Acta Neuropathologica, Vol. 115, No. 3, 2008, pp. 345-356. doi:10.1007/s00401-007-0338-y
[5]	A. J. Ferreri, M. Reni, F. Pasini, et al., “A Multicenter Study of Treatment of Primary CNS Lymphoma,” Neurology, Vol. 58, No. 10, 2002, pp. 1513-1520. doi:10.1212/WNL.58.10.1513
[6]	A. Ferreri, L. Abrey, J. Y. Blay, et al., “Summary Statement on Primary Central Nervous System Lymphomas from the Eighth International Conference on Malignant Lymphoma: Special Article,” Journal of Clinical Oncology, Vol. 21, No. 12, 2003, pp. 2407-2414. doi:10.1200/JCO.2003.01.135
[7]	A. J. Ferreri, J. Y. Blay, M. Reni, et al., “Prognostic Scoring System for Primary CNS Lymphomas: The International Extranodal Lymphoma Study Group Experience,” Journal of Clinical Oncology, Vol. 21, No. 2, 2003, pp. 266-272. doi:10.1200/JCO.2003.09.139
[8]	N. Hayabuchi, Y. Shibamoto and Y. Onizuka, “Primary Central Nervous System Lymphoma in Japan: A Nationwide Survey,” International Journal of Radiation Oncology * Biology * Physics, Vol. 44, No. 2, 1999, pp. 265-272. doi:10.1016/S0360-3016(98)00564-1
[9]	T. R. Cote, A. Manns, C. R. Hardy, F. J. Yellin, P. Hartge, AIDS/Cancer Study Group, “Epidemiology of Brain Lymphoma among People with or without Immunodeficiency Syndrome,” Journal of the National Cancer Institute, Vol. 88, No. 10, 1996, pp. 675-679. doi:10.1093/jnci/88.10.675
[10]	C. Sarkar, M. Sharma, P. Deb, et al., “Primary Central Nervous System Lymphoma-A Hospital Based Study of Incidence and Clinicopathological Features from India (1980-2003),” Journal of Neuro-Oncology, Vol. 71, No. 2, 2005, pp. 199-204. doi:10.1007/s11060-004-1385-z
[11]	M. Takeshita, O. Kubo, Y. Tajika, et al., “Primary Central Nervous System T-Cell Lymphoma-Case Report,” Neurologia Medico-Chirurgica (Tokyo), Vol. 39, No. 6, 1999, pp. 452-458. doi:10.2176/nmc.39.452
[12]	E. Villegas, S. Villa, A. Lopez-Guillermo, et al., “Primary Central Nervous System Lymphoma of T-Cell Origin: Description of Two Cases and Review of the Literature,” Journal of Neuro-Oncology, Vol. 34, No. 2, 1997, pp. 157-161. doi:10.1023/A:1005754212792
[13]	F. Hochberg and D. Miller, “Primary Central Nervous System Lymphoma,” Journal of Neurosurgery, Vol. 68, No. 6, 1988, pp. 835-853. doi:10.3171/jns.1988.68.6.0835
[14]	T. L. Helle, R. H. Britt and T. V. Colby, “Primary Lymphoma of the Central Nervous System: Clinicopathological Study of Experience at Stanford,” Journal of Neurosurgery, Vol. 60, No. 1, 1984, pp. 94-103. doi:10.3171/jns.1984.60.1.0094
[15]	E. Y. Kim and S. S. Kim, “Magnetic Resonance Findings of Primary Central Nervous System T-Cell Lymphoma in Immunocompetent Patients,” Acta Radiologica, Vol. 46, No. 2, 2005, pp. 187-192. doi:10.1080/02841850510022714
[16]	A. Harder, C. Dudel, I. Anagnostopoulos, et al., “Molecular Genetic Diagnosis of a Primary Central Nervous System T Cell Lymphoma,” Acta Radiologica, Vol. 105, No. 1, 2003, pp. 65-68.
[17]	L. M. Deangelis, W. Seiferheld, S. C. Schold, et al., “Combination Chemotherapy and Radiotherapy for Primary Central Nervous System Lymphoma. Radiation Therapy Oncology Group Study 93-10,” Journal of Clinical Oncology, Vol. 20, No. 24, 2002, pp. 4643-4648. doi:10.1200/JCO.2002.11.013