[Diffuse large B-cell lymphoma showing CNS invasion by CD30-positive multinuclear giant cells mimicking the clinical features of progressive multifocal leukoencephalopathy].
We report a 55-year-old woman with diffuse large B-cell lymphoma showing central nervous system (CNS) infiltration by CD30-positive lymphoma cells. The patient was admitted with pleural effusion, ascites and a large mass in the abdominal cavity. Southern blot analysis of DNA extracted from the ascites revealed IgJH rearrangement, and therefore she was initially diagnosed as B-cell neoplasia. She received combined chemotherapy (DICE and CHOP regimens), and achieved a transient clinical response. Three months later, she developed various neurological abnormalities, and brain magnetic resonance imaging revealed diffuse infiltration of the cerebral white matter. We considered the possibility of CNS involvement by the lymphoma or progressive multifocal leukoencephalopathy (PML), and began a course of anti-virus therapy and radiation therapy. Because multiple lumbar punctures demonstrated large multinuclear lymphoma cells in the cerebrospinal fluid, a diagnosis of metastatic CNS lymphoma was made. Immunohistochemistry revealed that these lymphoma cells were reactive with anti-CD30 antibody. Although the radiation therapy was temporarily effective against the CNS involvement, the patient died of systemic invasion of the lymphoma cells. The final diagnosis was diffuse large B-cell lymphoma on the basis of pathologic findings, immunohistochemistry, and Southern blot analysis using a mesenteric lymph node obtained at autopsy. Cytospin preparations and immunohistochemistry of specimens obtained from frequent lumbar punctures were useful for differentiating CNS lymphoma from PML.
First Department of Internal Medicine, Tokyo Medical University.
K
K
Ando
T
T
Shimamoto
S
S
Hayashi
Y
Y
Ito
Y
Y
Kawanishi
K
K
Miyazawa
Y
Y
Kimura
H
H
Serizawa
Y
Y
Ebihara
K
K
Ohyashiki
D001932:Brain Neoplasms / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017730:Ki-1 Antigen / Q000134:cerebrospinal fluid*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D013120:Spinal Cord Neoplasms / Q000473:pathology*
D017730:Ki-1 Antigen