Primary diffuse large B-cell lymphoma of the CNS, with a “Lymphomatosis cerebri” pattern

Thirunavukkarasu, Balamurugan; Gupta, Kirti; Shree, Ritu; Prabhakar, Anuj; Kapila, Aastha Takkar; Lal, Vivek; Radotra, Bishan

doi:10.4322/acr.2021.250

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Sumário

Autopsy Case Report • Autops. Case Rep. 11 • 2021 • https://doi.org/10.4322/acr.2021.250 copy

Primary diffuse large B-cell lymphoma of the CNS, with a “Lymphomatosis cerebri” pattern

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

We describe an unusual case of lymphomatosis cerebri in a middle-aged lady presenting with rapid-onset dementia. The lymphomatous infiltrate, instead of forming mass lesions, percolated throughout the brain parenchyma, which is often missed on a stereotactic biopsy and hence warrants caution and awareness about this entity. The nonspecific symptoms at presentation and a variable picture at imaging make this entity diagnostically challenging.

Keyword
s; Central Nervous System Neoplasm; Lymphomatosis cerebri, Non-Hodgkin lymphoma; Dementia

Test	result	RR	Test	result	RR
Hb (g/dl)	10.9	12-15.5	Ca+ (mg/dl)	8.8	8.8-10.2
RBC (10¹²/L)	3.5	4.0-5.2	PO4 (mg/dl)	2.8	2.7-4.5
Ht (%)	34.2	36-46	Mg+ (mg/dl)	1.6	1.58-2.55
RDW (%)	18.2	11-14.5	AST (U/L)	21	2-40
MCV	81.6	80-100	ALT (U/L)	10	2-41
MCHC	32	31-37	ALP (U/L)	80	42-128
TLC (/mm³)	18000	4000-11000	T bil (mg/dl)	1.2	0.2-1.2
Plt (x10⁵/m)	2,51	1,5 -4,5	D bil (mg/dl)	0.3	0-0.3
ESR (mm - 1^st hour)	11	2-20	total protein (g/dl)	5.7	6.4-8.3
CRP (mg/L)	24.69	<10	albumin (g/dl)	3.3	3.4-4.8
Creatinine (mg/dl)	0.7	0.5-1.2	uric acid (mg/dl)	4.1	3.5-7.0
Urea (mg/dl)	13	10-50	LDH (U/L)	319	135-225
Sodium (mEq/L)	135	135-145	procalcitonin (ng/ml)	0.17	0.01-0.50
Potassium (mEq/L)	3.6	3.5-5.0	Ammonia (µmol/L)	44.5	19-71
Chloride (mEq/L)	101	90-107	HbsAg/ Anti HCV/ HIV	Non-reactive	-

Hospital Universitário da Universidade de São Paulo Hospital Universitário da Universidade de São Paulo, Av. Prof. Lineu Prestes, 2565 - Cidade Universitária, 05508-000 - São Paulo - SP - Brasil, (16) 3307-2068, (16) 3307-2068 - São Paulo - SP - Brazil
E-mail: autopsy.hu@gmail.com

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[1] Authors’ contributions: Balamurugan Thirunavukkarasu assisted in autopsy analysis, critically reviewed the literature and drafted the manuscript, Kirti Gupta performed the autopsy analysis and diagnosed the case, critically reviewed the literature and drafted the manuscript. Ritu Shree managed the patient clinically, and reviewed the literature. Anuj Prabhakar performed the imaging and Radiological analysis, reviewed the literature. Aastha Takkar Kapila managed the patient clinically, reviewed the literature. Vivek Lal: managed the patient clinically, reviewed the literature. All authors proofread the final version and approved the manuscript for publication.

Protein (mg/dl)	33	15-60
Glucose (mg/dl)	51	45-80
Cytology	Lymphocytic pleocytosis	-
Gram stain	Negative	-
Culture	Sterile	-
India ink	Negative	-
Cryptococcal antigen	Negative	-
Ziehl-Neelsen stain	Negative	-
HSV PCR	Negative	-