Primary burkitt lymphoma of the brain in an immunocompetent patient. Case report

Immune-Mediated Hypertrophic Pachymeningitis and its Mimickers: Magnetic Resonance Imaging Findings

Hypertrophic pachymeningitis (HP) is a rare and chronic inflammatory disorder presenting as localized or diffuse thickening of the dura mater. It can be idiopathic or an unusual manifestation of immune-mediated, infectious, and neoplastic conditions. Although some cases may remain asymptomatic, HP can lead to progressive headaches, cranial nerve palsies, hydrocephalus, and other neurological complications, which makes its recognition a fundamental step for prompt treatment. Regarding the diagnosis workup, enhanced MRI is the most useful imaging method to evaluate dural thickening. This article addresses the MR imaging patterns of immune-mediated HP, including immunoglobulin G4-related disease, neurosarcoidosis, granulomatosis with polyangiitis, rheumatoid pachymeningitis, and idiopathic HP. The main infectious and neoplastic mimicking entities are also discussed with reference to conventional and advanced MR sequences.

Rare central nervous system lymphomas

Central nervous system (CNS) lymphomas are rare malignancies characterised by lymphoid infiltration into the brain, spinal cord, cranial nerves, meninges and/or eyes in the presence or absence of previous or concurrent systemic disease. Most CNS lymphomas are of the diffuse large B-cell lymphoma (DLBCL) subtype for which treatment strategies, particularly the use of high-dose methotrexate-based protocols and consolidation with autologous stem cell transplantation, are well established. Other histopathological subtypes of CNS lymphoma are comparatively less common with published data on these rare lymphomas dominated by smaller case series and retrospective reports. Consequently, there exists little clinical consensus on the optimal methods to diagnose and manage these clinically and biologically heterogeneous CNS lymphomas. In this review article, we focus on rarer CNS lymphomas, summarising the available clinical data on incidence, context, diagnostic features, reported management strategies, and clinical outcomes.

Primary CNS Burkitt Lymphoma: A Case Report of a 55-Year-Old Cerebral Palsy Patient

With primary central nervous system lymphoma (PCNSL) being a rare disease, the subtype of Burkitt lymphoma (BL) presenting as a sole CNS lesion is an even more exceptional diagnosis. A case of coexistent primary CNS Burkitt lymphoma (PCNSBL) with cerebral palsy (CP) is presented. A 55-year-old Caucasian male presented with increasing bilateral lower extremity weakness above his baseline in addition to signs of increased intracranial pressure. Four abnormal enhancing masses were detected on MRI with biopsy results consistent with Burkitt lymphoma. Complete staging workup was completed with no evidence of extra-CNS disease noted on PET/CT, bone marrow biopsy, or cerebral spinal fluid analysis. The patient was treated with intravenous as well as intrathecal chemotherapy and found to be in a complete remission at six months. Recurrence in the CNS was observed four months later with treatment consisting of whole brain radiation as well as intrathecal chemotherapy. Thirty months after diagnosis, the patient remains disease-free. To our knowledge, this is the first case of PCNSBL in the setting of CP. A review of literature regarding treatment options in this controversial setting is provided.

Burkitt lymphoma with initial clinical presentation due to infiltration of the central nervous system and eye orbits

Patient: Male, 17

Final Diagnosis: Burkitt lymphoma

Symptoms: Anisocoria, ipsilateral ptosis, opthalmoparesis, paresis

Medication: —

Clinical Procedure: —

Specialty: Oncology

Primary burkitt lymphoma of the fourth ventricle in an immunocompetent young patient

Primary Burkitt lymphoma of the central nervous system (CNS) is rare, with only few cases reported in the literature. An 18 year-old immunocompetent male presented with multiple cranial nerves palsies and was found to have a mass predominantly in the 4th ventricle of the brain. Tumor was surgically removed and showed morphological and immunohistochemical features consistent with Burkitt lymphoma. The patient responded very well to anthracycline based chemotherapy with high dose methotrexate (HD MTX) and intrathecal (IT) chemotherapy delivered by Ommaya reservoir. Primary Burkitt lymphoma of the CNS is a rare entity that poses differential diagnostic challenge with other small round blue cell tumors.

Primary central nervous system burkitt lymphoma with non-immunoglobulin heavy chain translocation in right ventricle: case report

Primary central nervous system Burkitt lymphoma (PCNSBL) is rare. Few cases of primary central nervous system involvement with sporadic Burkitt lymphoma have been reported and its treatment is now controversial. Here, the authors report a case of a 14-year-old boy suffering from non-immunoglobulin heavy chain (IgH) translocation PCNSBL. To the authors' knowledge, this is the second case report describing primary Burkitt lymphoma involving cerebral ventricles. After receiving combination treatment with surgery, stereotactic radiosurgery, and a chemotherapy regimen including high-dose methotrexate, the patient had a disease-free survival of 18 months.

Primary central nervous system Burkitt lymphoma as concomitant lesions in the third and the left ventricles: a case study and literature review

This study reports the case of a 75-year-old woman with intermittent speech disturbance, headache, and general malaise. Brain magnetic resonance imaging showed a double lesion located in the third ventricle and temporal horn of the lateral ventricle. We completely removed the lesion in the third ventricle, adhering to the septum pellucidum. The histopathological diagnosis was Burkitt lymphoma, which was confirmed to be primary in postoperative investigation. To our knowledge, this is the first case of primary Burkitt lymphoma involving cerebral ventricles. Finally, we reviewed the characteristics of primary central nervous system Burkitt lymphoma.

Case report. Primary hypothalamic third ventriclular Burkitt's lymphoma: a case report with emphasis on differential diagnosis

A patient with primary Burkitt-type lymphoma of the central nervous system is presented. A hypothalamic-third ventricular tumour in a man 71 years of age was diagnosed histologically as Burkitt's lymphoma. Primary Burkitt's lymphoma of the hypothalamic region is extremely rare and has not been previously reported in adults.

Rare pathological variants and presentations of primary central nervous system lymphomas

Primary central nervous system lymphoma (PCNSL) is a rare form of primary brain neoplasm, accounting for less than 3% of all primary brain tumors. Ninety percent of cases involve a large B-cell lymphoma that presents as a homogeneously enhancing lesion or lesions, typically deep-seated in the brain parenchyma. The authors describe unusual pathological forms of PCNSLs, including low-grade, T-cell, and Burkitt types, and also rare presentations such as neurolymphomatosis and pituitary lymphomas.

Efficacy of celecoxib in the treatment of CNS lymphomas: an in vivo model

Object

The incidence of primary central nervous system lymphomas (PCNSLs) has increased over the past several decades. Unfortunately, even with the most effective therapeutic regimen (that is, methotrexate with whole-brain radiation therapy), PCNSL recurs within a few years in more than half of the treated patients and is eventually fatal. Because PCNSL usually occurs in older patients and in those with acquired immunodeficiency syndrome, combination treatments in which both chemo- and radiation therapy are used is often poorly tolerated and results in a significant reduction in the quality of life. Recently, it has been demonstrated that the selective cyclooxygenase-2 inhibitor celecoxib (Celebrex), can block the growth of lymphoma cells in vitro.

Methods

To create an experimental animal model in vivo for the PCNSL study, the authors intracranially injected a human B-cell lymphoma cell line into nude mice. Their data demonstrate that this experimental model is an excellent one for human PCNSL with brain and leptomeningeal involvement. They also evaluated the feasibility of using celecoxib as a therapeutic agent in the treatment of PCNSL. Nude mice with intracranial lymphomas were treated with celecoxib contained in the animal chow. The treated animals demonstrated significantly prolonged survival times compared with the untreated animals.

Conclusions

Based on the authors' data, celecoxib may be a promising therapeutic agent for the treatment of PCNSL.

Primary meningeal Burkitt-type lymphoma presenting as the first clinical manifestation of acquired immunodeficiency syndrome

The purpose of this study is to report a rare case of primary meningeal high grade Burkitt-type lymphoma presenting as the first clinical manifestation of acquired immunodeficiency syndrome. A 38-year-old Caucasian man, with a negative past medical history, sought treatment after experiencing global headache for five days. CT-Scan revealed a right front-temporo-parietal hyperdense subdural expansive mass. A craniotomy was performed and a hard white subdural was microsurgically dissected. Some hours after the surgery, the patient developed hemispheric cerebral edema and intracranial hypertension syndrome. Decompressive craniotomy was performed and the patient had an excellent recovery. Screening blood tests diagnosed human immunodeficiency virus infection. Further investigation ruled out systemic diseases. Eleven days after the initial surgery, the patient developed an acute respiratory failure and sepsis, dying on that day. Pathological studies diagnosed Burkitt-type lymphoma.

Primary central nervous system lymphomas in immunocompetent patients

OBJECTIVES

Primary central nervous system lymphoma (PCNSL) is a rare pathology and is most often seen in immunodeficient patients. This article presents our casuistic of PCNSL in immunocompetent patients and make a literature review on this issue with focus on recent advances, investigations, and controversies in diagnosis and management of this pathology.

MATERIAL AND METHODS

Nine patients operated in the last years in our clinics are analysed in relation to sex, age, time of symptoms, procedures and adjuvant treatment. Posteriorly the results are compared with those in the preview literature.

RESULTS

The age ranged from 44-68 years (middle of 66 years); 62.5% of the patients were female. The mean time of symptoms, when the diagnostic was made, was 3.2 months (range 1-6 months). The most common symptoms were hemiparesis (present in 75% of the patients) headache (37.5%) seizures (25%) and ataxia (25%). The most common localization was the parietal, frontal and temporal lobe surface with 25% of the patients for each localization. Five patients (50%) were treated with stereotactic biopsy, three with surgery (37.5%) and one (12.5%) with both of them. Five patients (62.5%) were submitted to pos-operative radiotherapy as adjuvant treatment. In relation to the histology, the most common cell type was Diffuse B Cells.

CONCLUSIONS

This study demonstrated that complete surgical resection followed by radiotherapy have shown good results. In opposition to the literature, the authors regard chemotherapy as a secondary line treatment and recommend its use only in some selected cases.

Adult Burkitt's Lymphoma

Burkitt's lymphoma is a mature B-cell lymphoma that is characterized by a rapid proliferative rate and propensity for extranodal sites of involvement such as the gastrointestinal tract and central nervous system. This subtype of non-Hodgkin's lymphoma is associated with unique cytogenetic translocations involving the c-MYC oncogene on chromosome 8, which appears to be involved in the pathogenesis of this disease. Although current literature is limited by a lack of randomized trials, Burkitt's lymphoma appears to be curable in a high proportion of cases if treated with aggressive multiagent chemotherapy regimens. The use of autologous stem cell transplantation appears to benefit patients who have had chemotherapy-sensitive relapses. The role of allogeneic stem cell transplantation for this disease remains uncertain. Patients with HIV-associated Burkitt's lymphoma appear to have a better prognosis today, which is likely a result of more effective antiretroviral therapy and the ability to treat selected patients with more aggressive chemotherapeutic regimens than before. This article will review the epidemiologic, biologic, diagnostic, and therapeutic aspects of Burkitt's lymphoma in adults.