title: Primary central nervous system ALK-positive anaplastic large cell lymphoma in an adult: A rare case report.
abstract: BACKGROUND
  Anaplastic large cell lymphoma (ALCL) is an aggressive non-Hodgkin lymphoma. It mostly invades lymph nodes with extranodal involvement observed in the soft tissue, bone, and skin.
  
  
  METHODS
  We report a 34-year-old Chinese male patient who presented with headache, diplopia, and vomit. Cerebrospinal fluid (CSF) analysis via lumbar puncture showed elevated CSF pressure, elevated CSF protein concentrations, decreased CSF glucose and chloride concentration significantly, and pleocytosis of 68 to 350 × 10/L, in which lymphocytes and monocytes were predominant. These changes could be suggestive of tuberculous (TB) meningitis. Enhanced magnetic resonance imaging of spinal cord delineated multiple enhancing nodules in spinal cord, cauda equina, and cristae membrane, and multiple abnormal enhancing lesions in bilateral lumbar intervertebral foramen.
  
  
  METHODS
  Spinal dura mater biopsy and paraffin pathology examination revealed anaplastic lymphoma kinase positive ALCL.
  
  
  METHODS
  High-dose methotrexate, cytosine arabinoside craniospinal, and radiotherapy.
  
  
  RESULTS
  Last follow-up on September 22, 2015 showed no evidence of tumor recurrence and the lower extremity muscle strength recovered to 4/5.
  
  
  CONCLUSIONS
  ALCL of primary central nervous system is an exceedingly rare tumor, which is usually misdiagnosed as meningitis (especially TB meningitis) according to clinical manifestation and laboratory examination. Thus closely monitoring patient's conditions and timely adjusting therapeutic regimen during treatment are necessary.
authors.affiliation: Department of Infectious Diseases, Center for Liver Diseases, Peking University First Hospital, Xicheng, Beijing, China.
authors.forename: Xiaoqin
authors.initials: X
authors.lastname: Dong
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Na
authors.initials: N
authors.lastname: Huo
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Zhao
authors.initials: Z
authors.lastname: Wu
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Lin
authors.forename: Hong
authors.initials: H
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000077548:Anaplastic Lymphoma Kinase; D000971:Antineoplastic Combined Chemotherapy Protocols; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D003937:Diagnosis, Differential; D006261:Headache / Q000209:etiology; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D020794:Receptor Protein-Tyrosine Kinases / Q000097:blood*; D014057:Tomography, X-Ray Computed
chemical_list: C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases