title: Primary central nervous system plasmablastic lymphoma presenting in human immunodeficiency virus-negative but Epstein-Barr virus-positive patient: a case report.
abstract: We report a 32-year-old Outer Mongolian man, with plasmablastic lymphoma (PBL) primarily occured in the central nervous system and diagnosed by surgical resection. This patient appeared headache and magnetic resonance imaging (MRI) showed multiple lesions in the right cerebral hemisphere including the right frontal-parietal lobe and right basal ganglia and the left cerebellum, he was diagnosed as lymphoma by stereotactic biopsy in January 2009 in local hospital, and was given radiotherapy 33 times after the biopsy. The patient was admitted to The Military General Hospital of Beijing PLA., Beijing, P.R. China on March 9th, 2011, with chief complaints of right limbs convulsioned suddenly, then fell down and lose of his consciousness, then awoke after 4 to 5 minutes, with symptoms of angulus oris numbness and the right upper limb powerless ten days ago.MRI of the brain revealed a well-defined hyperdense and enhancing mass in the left frontal-parietal lobe, the meninges are closely related, there was extensive peritumoural edema noted with pressure effects, as evident by effacement of the left lateral ventricles and a 0.5 cm shift of the midline to the right side.Surgical resection showed markedly atypical, large singly dispersed or cohesive proliferation of plasmacytoid cells with frequent abnormal mitoses and binucleation, some neoplastic cells were large with round or oval nuclei and showed coarse chromatin and smaller or unapparent nucleoli, some neoplastic cells with prominent nucleoli, apoptosis and necrosis were often presented. Immunohistochemistry staining and gene rearrangement together with other supportive investigation confirmed the diagnosis of primary central nervous system plasmablastic lymphoma. A month later, he was started on chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, leurocristime and prednisone) for a week. Other supportive treatment was provided for symptomatic epilepsy. The patient regained muscle strength in both upper limbs and right lower limb and the symptomatic epilepsy was controlled after two weeks. Then the patient was discharged. Follow-up data shows the patient to be alive eleven months after discharge.
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authors.affiliation: Department of Pathology, The Military General Hospital of Beijing PLA, Members of Chinese Medical Association, Dongcheng District, Beijing, People's Republic of China.
authors.forename: Li Ying
authors.initials: LY
authors.lastname: Zhang
authors.forename: Hui Yun
authors.initials: HY
authors.lastname: Lin
authors.forename: Lan Xiang
authors.initials: LX
authors.lastname: Gao
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.forename: Yu Wang
authors.initials: YW
authors.lastname: Tian
authors.forename: Zhi Qin
authors.initials: ZQ
authors.lastname: Liu
authors.forename: Xiao Hua
authors.initials: XH
authors.lastname: Shi
authors.forename: Zhi Yong
authors.initials: ZY
authors.lastname: Liang
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D001706:Biopsy; D016543:Central Nervous System Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy / Q000821:virology; D004279:DNA, Viral / Q000302:isolation & purification; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D015321:Gene Rearrangement; D006678:HIV / Q000302:isolation & purification; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D016403:Lymphoma, Large B-Cell, Diffuse / Q000737:chemistry / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy / Q000821:virology; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D004279:DNA, Viral