title: Primary leptomeningeal B-cell lymphoma with normal pressure hydrocephalus at diagnosis.
abstract: An 80-year-old man, presenting with gait disturbance and memory loss, had findings of normal pressure hydrocephalus. Primary leptomeningeal lymphoma (PLML) was diagnosed based on cytology and flow cytometry of cerebrospinal fluid obtained by examination. Gadolinium-enhanced MRI showed enhancement of the brain and spinal cord but FDG-PET/CT revealed no lymph node swelling. With intrathecal chemotherapy, meningeal lesions disappeared and the gait disturbance and memory loss improved. However, the disease recurred three months later, manifesting as left facial nerve palsy, but the symptoms disappeared in response to intrathecal chemotherapy and systemic rituximab administration. Although a tumor lesion in the spinal canal was suggested by MRI examination, the patient has maintained a good clinical course for four years with intrathecal chemotherapy every three months. PLML is a very rare disease and its diagnosis is difficult. Repeated intrathecal chemotherapy appeared to be effective against PLML in this case.
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medicine, Gunma University.
authors.forename: Takuma
authors.initials: T
authors.lastname: Ishizaki
authors.forename: Takeki
authors.initials: T
authors.lastname: Mitsui
authors.forename: Yuri
authors.initials: Y
authors.lastname: Uchiyama
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Hiromi
authors.initials: H
authors.lastname: Koiso
authors.forename: Makiko
authors.initials: M
authors.lastname: Takizawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yokohama
authors.forename: Takayuki
authors.initials: T
authors.lastname: Saitoh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Handa
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsukamoto
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Murakami
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nojima
mesh_terms: D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D016393:Lymphoma, B-Cell / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D055756:Meningeal Carcinomatosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000069283:Rituximab / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000069283:Rituximab; D003907:Dexamethasone