21 June 2022>: Articles
Primary Central Nervous System Burkitt Lymphoma, Presenting with Long-Term Fluctuating Level of Consciousness: A Case Report and Literature Review on Challenges in Diagnosis and Management
Challenging differential diagnosis, Rare disease
Salem M. Bahashwan A* , Osman O. Radhwi D , Hatem M. Alahwal B , Abdullah T. Almohammadi C , Ahmed S. Barefah A , Yara M. Daous E , Fahad A. Alghamdi BDOI: 10.12659/AJCR.936401
Am J Case Rep 2022; 23:e936401
Table 1. Reported cases of primary central nervous system lymphoma in the literature, the multiple approaches used for treatment, and the outcomes.
Author | Year | Age | Gender | Presenting symptoms | Modality of diagnosis | Location |
---|---|---|---|---|---|---|
Valsamis et al []6 | 1976 | 6 month | M | Fever, vomiting, seizure | Tissue biopsy | Left parietal,bilateral temporal with abdominal and peeriaortic lymph node involvement |
Gawish et al []7 | 1976 | 8 year | M | Left frontal fungating mass without neurological symptoms | Tissue biopsy | Left frontal lobe |
Gigormini et al []18 | 1981 | 11 year | M | Headache and confusion | Tissue biopsy | Left temporo-occepital |
Kobayashi et al []27 | 1984 | 55 year | F | Headache | Tissue biopsy | Right temporo-parietal |
Hegedus []28 | 1984 | 50 year | F | Seizures, vomiting | Post mortum autopsy | Right lower parietal |
Pui et al []29 | 1985 | 6 year | M | Paraplasia, loss of sensation below T8 | Tissue biopsy | Epidural mass T2–T5 |
Pui et al []29 | 1985 | 14 year | F | Paresis and parasthesia of right lower extremity | Tissue biopsy | Epidural mass L5–S1, left axillary lymph nodes, pleura, and abdomen. |
Pui et al []29 | 1985 | 7 year | M | Paraplasia | Tissue biopsy | Epidural mass C7–T4 |
Pui et al []29 | 1985 | 12 year | M | Paraplasia, loss of sensation below T11 | Tissue biopsy | Epidural mass T7–T10 |
Mizugami et al []30 | 1987 | 6 year | M | Back pain, paraplasia | Tissue biopsy | Epidural mass T10 |
Mizugami et al []30 | 1987 | 5 year | M | Parasthesia in lower limb, difficulty in walking | Tissue biopsy | Epidural mass L2–L3 |
Mizugami et al []30 | 1987 | 7 year | F | Sensory and motor disturbances | Tissue biopsy | Epidural mass T11 |
Shigemori et al []31 | 1991 | 49 year | M | Headache, memory disturbance and weakness in right lower extremities | CT, MRI and carotid angiogram and tissue biopsy | Left frontal lobe |
Tekkok et al []32 | 1991 | 5 year | M | Headache and loss of vision in left eye | CT and tissue biopsy | Parasellar mass extended to bilateral sphenoid bone and sella turcica |
Toren et al []33 | 1994 | 6 year | F | Ataxia, external ophthalmoplegia, facial diplegia, chewing and swallowing difficulties and irritability | CSF analysis | Brain CSF? |
Spath-Schwalbe et al []8 | 1999 | 40 year | M | Positional vertigo, nausea and vomiting | MRI and tissue biopsy | Cerebellum and pons |
Mora et al []9 | 1999 | 9 year | M | Low back pain then unable to walk | Myelogram and histopathology | Epidural T9-11 mass |
Mora et al []9 | 1999 | 18 year | M | Low back pain, then unable to walk, sever constipation and bladder incontinence | Myelogram and histopathology | T11 |
Wilkerning et al []10 | 2001 | 43 year | F | Lumboischialgia, hypaesthesia of the right leg and radicular pain | Spine MRI and histopathology | L2-3 epidural tumor involving the dura and cauda equina |
Monabati et al []11 | 2002 | 49 year | F | Emotional disorder, left-sided weakness | MRI and histopathology | Right parietal mass |
Daley et al []12 | 2003 | 13 year | F | Low back pain, a burning sensation in the vaginal area, and difficulty voiding then unable to walk | Spine MRI and histopathology | L1-2 epidural mass |
Shehu et al []13 | 2003 | 8 year | M | Headache, lower right limb weakness and protrusion of the right eye. Later on blurred vision in the right eye and diplopia | CT brain and tissue biopsy | Left temporal and right orbit masses |
Huisman et al[]14 | 2003 | 12 year | M | Right ophthalmoplegia, exophthalmos, headache, nausea and vomiting | Brain CT, MRI, tissue biopsy and BM aspiration | Right cavernous sinus mass extending into the orbital apex |
Gobbato et al []15 | 2006 | 38 year | M | Headache | CT, craniotomy, excisional biopsy | Subdural, fronto-temporo-parietal |
Takasu et al []16 | 2010 | 71 year | M | Generalized fatigue, disorientation | CSF, CT, MRI, biopsy | Hypothalamus, 3 ventricle |
Gu et al []17 | 2010 | 75 year | F | Headache, speech disturbance | MRI, excisional biopsy | 3r and left ventricles |
Lim et al []19 | 2011 | 43 year | F | Headache | CSF, MRI, biopsy | Medulla-leptomeningeal seading |
Jiang et al []20 | 2011 | 14 year | M | Headache | MRI, excisional biopsy | Right lateral ventricle |
Akhaddar et al []21 | 2012 | 13 year | F | Right facial pain | MRI, biopsy | Temporal dura of the skull base, maxillary sinus |
Yoon et al []22 | 2012 | 10 year | M | Headache | CSF, MRI, biopsy | Suprasellar, cerebellum, 3 ventricle |
Yoon et al []22 | 2012 | 32 month | M | Lethargic features | CSF, MRI, biopsy | Sellar area extend to orbit |
Jiang et al []23 | 2012 | 69 year | M | Bilateral lower limb weakness and pain | CSF, MRI, biopsy | Right temporal and occepital lobe |
Alabdulsalam et al []24 | 2014 | 18 year | M | Ataxia, double vision, dysphagia, facial asymetry | CT, MRI, biopsy | Posterior fossa, 3 ventricle |
Bower et al []25 | 2018 | 55 year | M | Bilateral lower limb weakness | MRI, biopsy | Suprasellar, hypothalamus, right ventricle |
Patel et al []26 | 2019 | 7 year | M | Headache, decreased vision in left eye | MRI, excisional biopsy | Middle cranial fossa |
Author | Treatment | initial response | EFS | OS | ||
Valsamis et al []6 | Steroid, whole brain and spinal radiation with relapse, IT MTX | Partial response | 3 months | 20 months | ||
Gawish et al []7 | Total resection of tumor, chemotherapy (cyclophosphamide) | Complete response | >3 years | >3 years | ||
Gigormini et al []18 | Total resection of tumor | Complete response | >1 year | >1 year | ||
Kobayashi et al []27 | Total resection of tumor | Complete response | 1 month | 2 months | ||
Hegedus []28 | None | 3 months | ||||
Pui et al []29 | Laminectmy T2 to T5, chemotherapy CHOP without prednisone | Comlete response | >2 years | |||
Pui et al []29 | Raditherapy L3–S2, chemotherapy CHOP | Comlete response | 22 months | |||
Pui et al []29 | Laminectomy C7 to T4, radiotherapy C7–T12, dexamethasone, cyclophosphamide | Comlete response | 5 months | |||
Pui et al []29 | Laminectomy T7 to T10, chemotherapy CHOP | Comlete response | 4 months | |||
Mizugami et al []30 | Laminectomy T7 to T11, surgical resection, spinal irradiation, systemic chemotherapy, then leukemic transformation and CSF recurrence, IT MTX and cranial irradiation | Complete response | 20 months | |||
Mizugami et al []30 | Laminectomy T12 to T4, spinal irradiation, chemotherapy with systemic recurrence | Complete response | 7 months | |||
Mizugami et al []30 | Laminectomy T9 to L2, surgical resection, spinal irradiation, systemic chemotherapy | Refractory | 3 months | |||
Shigemori et al []31 | Resection, radiation, Chemotherapy, CHOP, MTX. | Good response | >6 months | |||
Tekkok et al []32 | Resection, chemotherapy, CHOP and MTX, craniospinal radiation. | Good response | >18 months | |||
Toren et al []33 | Steroids, IVIG, doxorubicin, vincristine, HD MTX, with IT MTX, cytarabine, and hydrocortisone. Changed to CHOP with MTX and IT MTX, cytarabine, hydrocortisone | Complete remission | > 2 years | |||
Spath-Schwalbe et al []8 | Chemotherapy combined with MTX then subsequent radiotherapy | Partial response initially then full remission after radiotherapy | >1 year | |||
Mora et al []9 | Laminectomy, chemotherapy via LSA3 protocol. Then received palliative radiation in second recurrence | Relapse | >1 year | |||
Mora et al []9 | Laminectomy, CHOP substitute daunorubicin for doxorubicin and radiation. | Relapse and refuse treatment | >8 months | |||
Wilkerning et al []10 | Surgical resection, radiation and IT MTX, cyclophosphamide, vincristin, methotrexate, ifosfamid, adriamycin, and dexamethasone | Good response | >2 years | |||
Monabati et al []11 | Complete resection, CHOP, and craniospinal radiation. Refused further treatment. | Good response | >6 months | |||
Daley et al []12 | Laminotomy, CHOP with MTX, and IT MTX and cytarabine and steroids. | Good response | >5 years | |||
Shehu et al []13 | Cy, vincristine, and MTX with IT cytosine arabinoside | Deteriorated progressively due to viral hepatitis then died | 11 months | |||
Huisman et al[]14 | IV and intrathecal chemotherapy according to the NHL-BFM-1995 protocol. Then anti-CD20 antibodies (rituximab) after relapse | Relapse, and died due to liver failure | 3 months | |||
Gobbato et al []15 | Total resection of tumor | Refractory | 11 days | |||
Takasu et al []16 | Partial resection, WBRT | Good partial response | ||||
Gu et al []17 | Total resection of tumor, WBRT | Complete response | >9 months | >9 months | ||
Lim et al []19 | Chemotherapy (HD-MTX based protocole) | Refractory | 6.7 months | |||
Jiang et al []20 | Total resection, gamma-knife therapy, chemotherapy (MPV) | Complete response | >18 months | >18 months | ||
Akhaddar et al []21 | Chemotherapy | Partial response | 3 months | |||
Yoon et al []22 | Systemic chemotherapy (HD-MTX and HD cytarabine), IT | Complete response | >86 months | >86 months | ||
Yoon et al []22 | Systemic chemotherapy (HD-MTX and HD cytarabine), IT | Complete response | 6 months | 9 months | ||
Jiang et al []23 | WBRT, chemotherapy (HD-MTX, cytarabine,rituximab) | Partial response | ||||
Alabdulsalam et al []24 | Total resection, chemotherapy(CHOP-R and HD-MTX), IT | Complete response | >18 months | >18 months | ||
Bower et al []25 | WBRT, chemotherapy (HD-MTX, cytarabine) | Complete response | >30 months | >30 months | ||
Patel et al []26 | Total resection, WBRT, chemotherapy(HD-MTX, cytarabine), IT | Complete response | >12 months | >12 months |