Diffuse large b-cell lymphoma of the choroid plexus: a case report

Abstract

Primary Central Nervous System Lymphoma (PCNSL) is a rare variant of extranodal non-Hodgkin lymphoma most commonly affecting the eyes, brain, spinal cord and leptomeninges. In the United States, it has a reported incidence of 51 cases per year. Among the subset of PCNSL are tumors arising primarily from the intraventricular regions including the choroid plexus. These cases are extremely rare and on literature review, only four cases have been documented worldwide. This is a case report of a confirmed B-cell lymphoma of the choroid plexus, the first reported case in the Philippines. CASE REPORT. This is a case of a 79-year-old-male with a 2 month-history of continuous headache accompanied by dizziness and seizures manifesting as blank stares and visual hallucinations. He was brought to the hospital with a decreased sensorium and dysarthria; his tongue deviated to the right; and has poor gag reflex. A cranial magnetic resonance imaging displayed enhancing frond-like structures with prominent lobulations in the body, frontal, and occipital horns of both lateral ventricles extending to the third and fourth ventricles with corresponding hydrocephalus. The primary diagnostic consideration on admission was CNS infection. He underwent left frontal burr, endoscopic biopsy of choroid plexus, exudates, and ependyma followed by septostomy and intraventricular lavage; and placement of an Ommaya reservoir. Histologic diagnosis was confirmed to be diffuse large B-cell lymphoma. A repeat cranial MRI, as well as neck, chest, mediastinum, and whole abdominal computed tomography scans showed no other neoplasm. Final diagnosis was diffuse large B-cell lymphoma of the choroid plexus. CSF cytology was negative for atypical cells. Systemic chemotherapy with methotrexate and rituximab was initiated. However, patient already had poor neurological response and the patient's family eventually decided to put patient on palliative care. Patient was eventually transferred to a smaller hospital facility after being admitted for five weeks.