Primary central nervous system lymphoma presenting as an acute massive intracerebral hemorrhage: case report with immunohistochemical study.
BACKGROUND
Hemorrhage at presentation in primary CNS lymphoma is extremely rare and only 2 studies have reported it. We experienced a case of hemorrhage in primary CNS lymphoma, but the feature was different from those in the 2 studies mentioned. We report a case of primary CNS lymphoma presenting as an acute massive ICH causing catastrophic mental deterioration, along with immunohistochemical profiles.


METHODS
A 49-year-old woman was admitted with sudden deterioration of mental status. Immediate CT scan showed a massive ICH in the left frontal lobe with perilesional edema and midline shifting. Emergency operation was performed and the hematoma was removed gross totally, including the abnormal lesions distinguished from adjacent normal brain. The histopathologic diagnosis was non-Hodgkin lymphoma, diffuse, large, B cell type with acute hemorrhage, and immunohistochemistry results showed high VEGF immunoreactivity and intermediate CD34 immunoreactivity.


CONCLUSIONS
Primary CNS lymphoma can present as an acute massive ICH, and immunohistochemistry in the present study strengthened the suggestion that VEGF activity is related to the hemorrhage in primary CNS lymphoma.
Kim
In-Young
IY
Department of Neurosurgery, Brain Tumor Clinic and Gamma Knife Center, Chonnam National University Hwasun Hospital, Chonnam 519-809, South Korea.
Jung
Shin
S
Jung
Tae-Young
TY
Kang
Sam-Suk
SS
Choi
Chan
C
D018952:Antigens, CD34 / Q000378:metabolism; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D001932:Brain Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D019299:Decompression, Surgical; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007150:Immunohistochemistry; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011878:Radiotherapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014474:Unconsciousness / Q000209:etiology / Q000473:pathology; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
D018952:Antigens, CD34; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D042461:Vascular Endothelial Growth Factor A