Unusual Presentation of Diffuse large β-cell Lymphoma (DLBCL) Lymphoma with diagnostic challenges DLBCL Lymphoma
Main Article Content
Abstract
Introduction:
Worldwide diffused β cell lymphoma is the commonest type of non-Hodgkin lymphoma about 31% of all non-Hodgkin Lymphoma. Median age reported for diffuse large β-cell lymphoma 60 to 70 years of age. Extra nodal diffuse large β-cell lymphoma reported in about 30% cases and most common site were found gastrointestinal tract skin and soft tissue bone or Genito urinary tract, head and neck region. Extra nodal non-Hodgkin lymphoma only represented in 10% cases.
Case Study:
Patients presented with complaint of focal neurological deficit vomiting, headache nausea and status seizures with behavioural and mental change and 27-year-old male presented with difficulty pain while walking for last 1.5 months.
Discussion:
Musculoskeletal Lymphomas are predominantly a manifestation of lymphoma dissemination. Extra nodal Lymphomas commonly involved skin, head and neck and gastrointestinal tract. Lymphomas rarely involved skeletal system. Most common radiological finding with Extra-Nodal lymphoma are blastic lesion and lytic lesion, sometimes mixed lesion with lytic and blastid. Primary central nervous system lymphoma usually originates from cerebellum, spinal cord, Pia matter, Retina or optic nerve. Manifestation of lymphoma in skeletal muscles is rare, usually they involve gluteal muscles and pelvis.
Conclusion:
Primary Central Nervous System (CNS) Lymphoma often misdiagnosed as Brain tumour and this delays proper treatment and confirmation of diagnosis. Immunohisto-chemistry examination is mandatory to achieve confirm diagnosis.
Keywords:
Lymphoma, β-cell lymphoma, CNS Lymphoma.
Article Details
How to Cite
DEVI, Dr. Seema; KUMAR, Dr. Abhishek; MINAKSHI, Dr. Priti.
Unusual Presentation of Diffuse large β-cell Lymphoma (DLBCL) Lymphoma with diagnostic challenges.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5657>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5657.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Ting C, Gan G, Bee‐Lan Ong D, Tan S, Bee P. Extranodal site of diffuse large B‐cell lymphoma and the risk of R‐CHOP chemotherapy resistance and early relapse. Int J Clin Pract. 2020;74(10). doi:10.1111/ijcp.13594
3. Bathla G, Hegde A. Lymphomatous involvement of the central nervous system. Clin Radiol. 2016;71(6):602-609. doi:10.1016/j.crad.2016.02.006
4. Swerdlow SH, Campo E, Harris NL. Bosman FT, Jaffe ES, Lakhani Ohgaki H, et al. WHO classification of tumours of haematopoietic SR, and lymphoid tissues. World Health Organization Classification of Tumours Lyon, France: IARC; 2008.
5. O’Neill BP, Decker PA, Tieu C, Cerhan JR. The changing incidence of primary central nervous system lymphoma is driven primarily by the changing incidence in young and middle-aged men and differs from time trends in systemic diffuse large B-cell non-Hodgkin’s lymphoma. Am J Hematol. 2013;88(12):997-1000. doi:10.1002/ajh.23551
6. Grommes C, DeAngelis LM. Primary CNS Lymphoma. J Clin Oncol. 2017;35(21):2410-2418. doi:10.1200/JCO.2017.72.7602
7. Bataille B, Delwail V, Menet E, Vandermarcq P, Ingrand P, Wager M, et al. Primary intracerebral malignant lymphoma: report of 248 cases. J Neurosurg. 2000;92(2):261-266. doi:10.3171/jns.2000.92.2.0261
8. Fischer L, Martus P, Weller M, Klasen HA, Rohden B, Röth A, et al. Meningeal dissemination in primary CNS lymphoma. Neurology. 2008;71 (14):1102-1108. doi:10.1212/01.wnl.0000326958.52546.f5
9. Chan CC, Rubenstein JL, Coupland SE, Davis JL, Harbour JW, Johnston PB, et al. Primary vitreoretinal lymphoma: a report from an International Primary Central Nervous System Lymphoma Collaborative Group symposium. Oncologist. 2011; 16(11):1589-1599. doi:10.1634/theoncologist.2011-0210
10. Alamdari A, Naderi N, Peiman S, Shahi F. Non-Hodgkin lymphoma with primary involvement of skeletal muscle. Int J Hematol Oncol Stem Cell Res. 2014;8(3):55-57.
11. Thomas AG, Vaidhyanath R, Kirke R, Rajesh A. Extranodal Lymphoma From Head to Toe: Part 2, The Trunk and Extremities. Am J Roentgenol. 2011;197(2):357-364. doi:10.2214/ajr.11.6738
12. Ilica AT, Kocacelebi K, Savas R, Ayan A. Imaging of Extranodal Lymphoma With PET/CT. Clin Nucl Med. 2011;36(10):e127-e138. doi:10.1097/rlu.0b013e31821c99cd
13. Zucca E. Extranodal lymphoma: a reappraisal. Ann Oncol. 2008;19:iv77-iv80. doi:10.1093/annonc/mdn204
14. Chua SC, Rozalli FI, O’Connor SR. Imaging features of primary extranodal lymphomas. Clin Radiol. 2009;64(6):574-588. doi:10.1016/j.crad.2008.11.001
15. Kashyap R, Rai Mittal B, Manohar K, Balasubramanian Harisankar CN, Bhattacharya A, Singh B, et al. Extranodal manifestations of lymphoma on [18F]FDG-PET/CT: a pictorial essay. Cancer Imaging. 2011;11(1):166-174. doi:10.1102/1470-7330.2011.0023
16. Braunstein EM, White SJ. Non-Hodgkin lymphoma of bone. Radiology. 1980;135(1):59-63. doi:10.1148/radiology.135.1.6892659
17. Gerstner ER, Batchelor TT. Primary Central Nervous System Lymphoma. Arch Neurol. 2010; 67(3). doi:10.1001/archneurol.2010.3
18. Senocak E, Oguz KK, Ozgen B, Mut M, Ayhan S, Berker M, et al. Parenchymal lymphoma of the brain on initial MR imaging: A comparative study between primary and secondary brain lymphoma. Eur J Radiol. 2011;79(2):288-294. doi:10.1016/j.ejrad.2010.01.017
19. Haque S, Law M, Abrey LE, Young RJ. Imaging of Lymphoma of the Central Nervous System, Spine, and Orbit. Radiol Clin North Am. 2008;46(2):339-361. doi:10.1016/j.rcl.2008.04.003
20. Server A, Josefsen R, Kulle B, Mæhlen J, Schellhorn T, Gadmar Ø, et al. Proton magnetic resonance spectroscopy in the distinction of high-grade cerebral gliomas from single metastatic brain tumors. Acta radiol. 2010;51(3):316-325. doi:10.3109/02841850903482901
21. Barajas Jr RF, Rubenstein JL, Chang JS, Hwang J, Cha S. Diffusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma. AJNR Am J Neuroradiol. 2010;31(1): 60-66. doi:10.3174/ajnr.A1750
22. Mohile NA, Deangelis LM, Abrey LE. The utility of body FDG PET in staging primary central nervous system lymphoma. Neuro Oncol. 2008;10(2):223-228. doi:10.1215/15228517-2007-061
23. Karantanis D, O’Neill BP, Subramaniam RM, Witte RJ, Mullan BP, Nathan MA, et al. 18F-FDG PET/CT in primary central nervous system lymphoma in HIV-negative patients. Nucl Med Commun. 2007;28(11):834-841. doi:10.1097/mnm.0b013e328264ae7f
24. Kawai N, Okubo S, Miyake K, Maeda Y, Yamamoto Y, Nishiyama Y, et al. Use of PET in the diagnosis of primary CNS lymphoma in patients with atypical MR findings. Ann Nucl Med. 2010; 24(5):335-343. doi:10.1007/s12149-010-0356-z
25. Raoux D, Duband S, Forest F, Trombert B, Chambonnière ML, Dumollard JM, et al. Primary central nervous system lymphoma: Immunohistochemical profile and prognostic significance. Neuropathology. 2009;30(3):232-240. doi:10.1111/j.1440-1789.2009.01074.x
26. Kinoshita M, Hashimoto N, Izumoto S, Okita Y, Kagawa N, Maruno M, et al. Immunohistological profiling by B-cell differentiation status of primary central nervous system lymphoma treated by high-dose methotrexate chemotherapy. J Neurooncol. 2010;99(1):95-101. doi:10.1007/s11060-010-0112-1
27. Kleihues P, Cavenee WK. Pathology and Genetics of Tumours of the Nervous System. IARC Press, Lyon. 2000:198-203,.
28. Angelov L, Doolittle ND, Kraemer DF, Siegal T, Barnett GH, Peereboom DM, et al. Blood-brain barrier disruption and intra-arterial methotrexate-based therapy for newly diagnosed primary CNS lymphoma: a multi-institutional experience. J Clin Oncol. 2009;27(21):3503-3509. doi:10.1200/JCO.2008.19.3789
29. Zhang D, Hu LB, Henning TD, Ravarani EM, Zou LG, Feng XY, et al. MRI findings of primary CNS lymphoma in 26 immunocompetent patients. Korean J Radiol. 2010;11(3):269-277.
doi:10.3348/kjr.2010.11.3.269
30. Basso U, Brandes AA. Diagnostic advances and new trends for the treatment of primary central nervous system lymphoma. Eur J Cancer. 2002;38 (10):1298-1312. doi:10.1016/s0959-8049(02)00031-x
31. Glantz MJ, Cole BF, Recht L, Akerley W, Mills P, Saris S, et al. High-dose intravenous methotrexate for patients with nonleukemic leptomeningeal cancer: is intrathecal chemotherapy necessary? J Clin Oncol. 1998;16(4):1561-1567. doi:10.1200/jco.1998.16.4.1561
32. Guha-Thakurta N, Damek D, Pollack C, Hochberg FH. Intravenous Methotrexate as Initial Treatment for Primary Central Nervous System Lymphoma: Response to Therapy and Quality of Life of Patients. J Neurooncol. 1999;43(3):259-268. doi:10.1023/A:1006210703827
33. Murakami M, Fujimaki T, Asano S, et al. Combination therapy with rituximab and temozolomide for recurrent and refractory primary central nervous system lymphoma. Yonsei Med J. 2011;52(6):1031-1034. doi:10.3349/ymj.2011.52.6.1031.
34. Makino K, Nakamura H, Hide T ichiro, Kuratsu J ichi. Salvage treatment with temozolomide in refractory or relapsed primary central nervous system lymphoma and assessment of the MGMT status. J Neurooncol. 2011;106(1):155-160. doi:10.1007/s11060-011-0652-z.
35. Yang Y, He J, Dang Y, Xia X, Dai Y and Xu R. One case report and literature review of primary central nervous system non Hodgkin's lymphoma. Lin Chuang Shen Jing Wai Ke Za Zhi. 2014; 5: 373-375 (In Chinese).
36. Weaver JD, Vinters H V, Koretz B, Xiong Z, Mischel P, Kado D. Lymphomatosis Cerebri Presenting as Rapidly Progressive Dementia. Neurologist. 2007;13(3):150-153. doi:10.1097/01.nrl.0000254706.85609.95
37. Suh C, Kim JE, Yoon DH. Relapse pattern and prognostic factors for patients with primary CNS lymphoma. Korean J Hematol. 2012;47(2) :155-156. doi:10.5045/kjh.2012.47.2.155
38. Mamorska-Dyga A, Ronny FMH, Puccio C, Islam H, Liu D. A rare case of the upper extremity diffuse large B-cell lymphoma mimicking soft tissue sarcoma in an elderly patient. Stem cell Investig. 2016;3:25. doi:10.21037/sci.2016.06.06
39. Mayo J, Bogenberger K, Raj T, Reha J. Subcutaneous mass concerning for sarcoma: a peculiar presentation of diffuse large B-cell lymphoma. BMJ Case Rep. 2019;12(7):e229327. doi:10.1136/bcr-2019-229327
40. Gupta P, Agarwal P, Ahuja A, Durga CK. Primary cutaneous non-Hodgkin’s lymphoma, clinically mimicking a soft tissue sarcoma. Cytojournal. 2018;15:2. doi:10.4103/cytojournal.cytojournal_41_17
41. Gao YH, Xu Q, Wei G, Liu HS, Wu X, Liu LH, et al. Primary giant lymphoma of the right thigh: A case report and brief review of the literature. Oncol Lett. 2012;4(5):1023-1026. doi:10.3892/ol.2012.848
42. Elsamaloty H, Zenooz NA, Alam T. Aggressive muscular non-Hodgkin lymphoma. Eur J Radiol Extra. 2006;58(2):27-30. doi:10.1016/j.ejrex.2006.02.009
43. Faraji-Goodarzi M. Sepsis after non-perforated acute appendicitis. Clin case reports. 2019;7(3):520-523. doi:10.1002/ccr3.2030
44. Masaoka S, Fu T. Malignant lymphoma in skeletal muscle with rhabdomyolysis: a report of two cases. J Orthop Sci. 2002;7(6):688-693. doi:10.1007/s007760200122
45. Laffosse JM, Gomez-Brouchet A, Molinier F, Chiron P, Roché H, Puget J. A case of malignant primary non-Hodgkin’s lymphoma in skeletal muscle treated by exclusive chemotherapy. Jt Bone Spine. 2009;76(1):86-88. doi:10.1016/j.jbspin.2008.02.022
46. Ferry JA. Extranodal Lymphoma. Arch Pathol & Lab Med. 2008;132(4):565-578.
doi:10.5858/2008-132-565-el
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