title: Cerebral low-grade lymphoma and light chain deposition disease: exceedingly high IgG levels in the cerebrospinal fluid as a diagnostic clue.
abstract: Herein, we report the case of a 72-year-old male with an exceedingly rare manifestation of a low-grade lymphoma in the brain associated with light chain deposition disease (LCDD). The patient presented with epileptic seizures. Magnetic resonance imaging (MRI) of the brain revealed multiple hyperintense lesions in the right parietal lobe that were suspicious of vasculitis, low-grade glioma, or neurosarcoidosis. In the cerebrospinal fluid (CSF), but not in the serum, highly elevated IgG was found. A stereotactic biopsy of one cerebral lesion was performed. Histopathology revealed a low grade lymphoplasmacytic B-cell lymphoma with light chain deposition disease (LCDD). Bone marrow biopsy and laboratory workup did not show any systemic involvement. LCDD exclusively affecting the brain is an exceedingly rare finding. It can be associated with low-grade B-cell lymphoma. This is the first report of LCDD exclusively affecting the brain in an elderly patient. Compared with the two younger patients previously reported, the course of the disease was of a slow-evolving nature. In constellations of highly elevated IgG in CSF and multiple white matter lesions, LCDD should be considered as underlying pathology.
authors.affiliation: Institute of Brain Research, University of Tuebingen, Germany. georgios.pantazis@med.uni-tuebingen.de
authors.forename: G
authors.initials: G
authors.lastname: Pantazis
authors.forename: T
authors.initials: T
authors.lastname: Psaras
authors.forename: K
authors.initials: K
authors.lastname: Krope
authors.forename: R
authors.initials: R
authors.lastname: von Coelln
authors.forename: F
authors.initials: F
authors.lastname: Fend
authors.forename: T
authors.initials: T
authors.lastname: Bock
authors.forename: J
authors.initials: J
authors.lastname: Schittenhelm
authors.forename: A
authors.initials: A
authors.lastname: Melms
authors.forename: R
authors.initials: R
authors.lastname: Meyermann
authors.forename: A
authors.initials: A
authors.lastname: Bornemann
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D001927:Brain Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology*; D001932:Brain Neoplasms / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid*; D007147:Immunoglobulin Light Chains / Q000378:metabolism*; D016393:Lymphoma, B-Cell / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G; D007147:Immunoglobulin Light Chains