Lymphoma of the central nervous system originating from the septum pellucidum region: Two case reports with literature review

RATIONALE

Non-Hodgkin lymphoma affecting the brain, eyes, and cerebrospinal fluid without systemic spread is known as primary central nervous system lymphoma (PCNSL). While intracerebroventricular PCNSL is commonly found in the lateral ventricles and the third and fourth ventricles, the occurrence of PCNSL originating from the septum pellucidum is extremely rare.

PATIENT CONCERNS

Two patients presented with recent memory loss and high cranial pressure.

DIAGNOSES

Magnetic resonance imaging revealed a clear enhancing lesion in the septum pellucidum region. Pathological examination confirmed that both cases were primary large B-cell lymphoma GCB (germinal center B-cell-like) subtypes located in an "immune-privileged" area.

INTERVENTIONS

Both patients underwent total tumor resection, and the procedures were successfully completed without surgical complications.

OUTCOMES

Over a 1-year period, treatment included four cycles of high-dose methotrexate combined with temozolomide. During the follow-up period (19-23 months), no recurrence of the lymphoma was observed.

LESSONS

In cases of PCNSL in the septum pellucidum, it is crucial to consider it as a potential differential diagnosis for intraventricular tumors. Surgical interventions should focus on maximizing tumor resection while ensuring the protection of critical structures like the fornix and peripheral neural components. The role of surgery compared to biopsy, as well as the long-term complications, necessitates extended follow-up. Additionally, an individualized treatment approach, considering factors such as age, Karnofsky performance score, and organ function assessment, can lead to positive outcomes.

Intraventricular Masson tumor: case report and systematic review of primary intracranial intravascular papillary endothelial hyperplasia

Intracranial Masson tumor (intravascular papillary endothelial hyperplasia, IPEH) is a benign lesion that is thought to originate from a reactionary process in response to compromised blood flow. IPEH may be classified into one of three subtypes based on etiology as it may result from the excessive proliferation of endothelial cells within a normal vessel (primary), vascular malformation (type II), or organized hematoma (type III). We report the case of a 79-year-old woman who presented with confusion, gait instability, and urinary incontinence. Neuroimaging revealed a hemorrhagic lesion within the right lateral ventricle, which was successfully resected. To our knowledge, this is the first reported case of an intraventricular IPEH and 33rd case of primary intracranial IPEH. We further performed a systematic review of the literature on all prior type I intracranial IPEH cases and discuss the importance of long-term follow-up in intracranial IPEH.

[Craniopharyngioma Mimicking Chordoid Glioma]

Entirely intrinsic third ventricular craniopharyngiomas showed characteristics of a round/oval shaped tumor, with rare calcification and cyst formation, and pathologically squamous-papillary type with a positive BRAF^V600E mutation. We report an extremely rare case of entirely intrinsic third ventricular craniopharyngioma, pathologically adamantiomatous but with BRAF^V600E mutation genetically, developed in a 35-year-old female. It was oval-shaped, with no calcification or cyst, and showed homogeneous enhancement. As shown in this case, it was difficult to differentiate this pathology from chordoid glioma of third ventricle, and the difficulty of this differential diagnosis has not been well documented in previous studies. Our case further implied the importance of molecular diagnosis for subclassification of craniopharyngioma. The BRAF^V600E-mutated craniopharyngioma could be the target for the development of treatment with preoperative BRAF-inhibitors. Therefore, differentiation between entirely intrinsic third ventricular craniopharyngiomas and chordoid glioma could be new issue. In this report, we discuss about the preoperative differential diagnosis from chordoid glioma and the literature review. (Received 12 August, 2021; Accepted 21 September, 2021; Published 1 February, 2022).

GLP-1 treatment reduces endogenous insulin resistance via activation of central GLP-1 receptors in mice fed a high-fat diet

Glucagon-like peptide-1 (GLP-1) improves insulin sensitivity in humans and rodents. It is currently unknown to what extent the (metabolic) effects of GLP-1 treatment are mediated by central GLP-1 receptors. We studied the impact of central GLP-1 receptor (GLP-1R) antagonism on the metabolic effects of peripheral GLP-1 administration in mice. High-fat-fed insulin-resistant C57Bl/6 mice were treated with continuous subcutaneous infusion of GLP-1 or saline (PBS) for 2 wk, whereas the GLP-1R antagonist exendin-9 (EX-9) and cerebrospinal fluid (CSF) were simultaneously infused in the left lateral cerebral ventricle (icv). Glucose and glycerol turnover were determined during a hyperinsulinemic euglycemic clamp. VLDL-triglyceride (VLDL-TG) production was determined in hyperinsulinemic conditions. Our data show that the rate of glucose infusion necessary to maintain euglycemia was significantly increased by GLP-1. Simultaneous icv infusion of EX-9 diminished this effect by 62%. The capacities of insulin to stimulate glucose disposal and inhibit glucose production were reinforced by GLP-1. Simultaneous icv infusion of EX-9 significantly diminished the latter effect. Central GLP-1R antagonism alone did not affect glucose metabolism. Also, GLP-1 treatment reinforced the inhibitory action of insulin on VLDL-TG production. In conclusion, peripheral administration of GLP-1 reinforces the ability of insulin to suppress endogenous glucose and VLDL-TG production (but not lipolysis) and boosts its capacity to stimulate glucose disposal in high-fat-fed C57Bl/6 mice. Activation of central GLP-1Rs contributes substantially to the inhibition of endogenous glucose production by GLP-1 treatment in this animal model.

Fourth ventricular hemangioblastoma associated with pheochromocytoma and renal medullary fibroma

Intraventricular hemangioblastomas are exceptionally rare. Of the cases described in the literature, very few were associated with von Hippel-Lindau disease. We present a highly unusual case of a fourth ventricular hemangioblastoma associated with a pheochromocytoma and a renal medullary fibroma. This may represent a forme fruste of the von Hippel-Lindau complex. A workup for papilledema resulted in the discovery of this rare finding.

Lipoma of cervical spinal cord and posterior fossa. Case report

A case is reported of cervical spinal cord lipoma with extension into the posterior fossa and a leading symptom of apnea. A C1-C7 laminectomy and debulking of the medullary portion of the lipoma were performed with good results. The apneic spells were completely resolved. Intraspinal lipoma with posterior fossa extension is a rare condition and requires surgical intervention to relieve symptoms.

Craniopharyngioma and "reactive" subependymoma of the third ventricle--a case report

A 42-year-old woman with an 18-year history of suprasellar tumor, treated by repeated radiation therapy and surgery, was found to have both a craniopharyngioma and subependymoma of the third ventricle. The case is unique in that well documented subependymomas have not been reported in this location. Furthermore, only a few cases of subependymoma have been reported to be accompanied by a primary tumor of the central nervous system other than an ependymoma. Potential causative factors for this seemingly reactive subependymoma are briefly discussed.

[Cerebral malformations in the oro-facio-digital syndrome of Papillon-Leage and Psaume (author's transl)]

Six children with an oro-facio-digital syndrome (Papillon-Leage and Psaume) underwent pneumoencephalography. In 3 cases, the examination was normal. In 3 cases, severe abnormalities were discovered. These abnormalities included: agenesis of the corpus callosum (3/3); a markedly asymmetric skull with enormous porencephalic cavities (2/3); heterotopia of the grey matter (2/3). There were no differences in neurological state nor I.Q. between the children with cerebral malformations and those with a normal pneumo-encephalogram. The association of agenesis of the corpus callosum and porencephaly is significant, and even more so if heterotopia is also present. In the presence of these abnormalities, the diagnosis of oro-facio-digital syndrome may be made even when the clinical picture is untypical.

Extraneural metastases in ependymoma of the cauda equina

A case of ependymoma of the cauda equina, presumably originating from the filum terminale in a girl aged 17 at the onset of illness, eventually developed remote metastases in the lungs, pleura, and one para-aortic lymph node. This case is compared with three other previously reported examples. The unusual features in the present instance were (1) the total length of the clinical history, amounting to 29 years; (2) the development, six years after the removal of the original spinal tumour, of another ependymomatous mass in the fourth ventricle, interpreted as a rostral metastasis that seeded via the cerebrospinal fluid; and (3) the demonstration of anaplastic cytological changes at the primary site, interpreted as the result of irradiation. The salient aspects of this and the three other reported cases are briefly reviewed, and the pathway of distant dissemination, resulting from venous permeation at the primary site, is emphasized.