Epstein-Barr Virus-Positive Primary Central Nervous System Lymphoma in a 40-Year-Old Immunocompetent Patient.
Epstein-Barr Virus-Positive Primary Central Nervous System Lymphoma in a 40-Year-Old Immunocompetent Patient.
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DOI：
10.7759/cureus.12754
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发表时间：
2021-01-17
期刊：
影响因子：
--
通讯作者：
Placantonakis DG
中科院分区：
文献类型：
--
作者：
Hajtovic S;Liu C;Diefenbach CM;Placantonakis DG
EB病毒阳性（EBV+）原发性中枢神经系统淋巴瘤（PCNSL）是一种临床实体很少报告的年轻免疫功能正常的患者。在此，我们报告一例40岁女性，无免疫抑制或免疫缺陷病史，右侧基底神经节环形增强病变。肿瘤产生显著的血管源性水肿和肿块效应，引起中线移位、颅内压升高症状和快速进展的神经功能障碍。她通过管状牵开器进行了肿瘤的全切除术。她的肿瘤是PCNSL的弥漫性大B细胞淋巴瘤（DLBCL）亚型，EBV阳性。未发现免疫缺陷或颅外疾病。经过大剂量甲氨蝶呤、利妥昔单抗和替莫唑胺的辅助治疗，她在初次就诊后两年内保持无病。EBV+ PCNSL虽然在年轻免疫功能正常的成年人中罕见，但会带来独特的临床挑战，在某些情况下可能需要在急性环境中进行手术干预。
Epstein-Barr virus-positive (EBV+) primary central nervous system lymphoma (PCNSL) is a clinical entity rarely reported in young immunocompetent patients. Here, we present the case of a 40-year-old female with no history of immunosuppression or immunodeficiency, who presented with a ring-enhancing lesion in the right basal ganglia. The tumor generated significant vasogenic edema and mass effect, causing midline shift, symptoms of increased intracranial pressure, and rapidly progressive neurologic dysfunction. She underwent gross total resection of the tumor through a tubular retractor. Her tumor was of the diffuse large B cell lymphoma (DLBCL) subtype of PCNSL and was positive for EBV. No immunodeficiency or extracranial disease was identified. After adjuvant therapy with high-dose methotrexate, rituximab, and temozolomide, she remains disease-free two years after initial presentation. EBV+ PCNSL, although rare in young immunocompetent adults, poses unique clinical challenges and may require surgical intervention in the acute setting in some cases.
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