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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | Sentinel & Steroid Rx Lesions | 4A0 Case 4 History
Case 4 History ---- The patient is a 61-year-old man with a three week history of personality changes and progressive, severe headaches. CT & MRI examinations demonstrated a heterogeneous enhancing right frontal lesion with surrounding edema, suspicious for neoplasm, causing mass effect on the right lateral ventricle. He was treated with high doses of Decadron at an outside hospital before being transferred here for biopsy. The well-sampled surgical specimen was composed of multiple fragments of tissue and showed two histologic processes involving separate pieces of the specimen: i) inflammation and demyelination with axonal sparing in the essential absence of neoplastic cells; and, ii) primary CNS large B cell lymphoma. The demyelinative component may reflect steroid treatment effect on lymphoma, although in that case pretreatment would have to have been nearly completely effective at removing neoplastic cells. In contrast to typical cases in which demyelination and lymphoma develop sequentially, In this case we have the two processes together. The patient underwent Rituxan with high-dose methotrexate for a total of 5 cycles and received ara-C for 2 cycles. He remained in remission for nearly 2 years until his tumor recurred. He then received 6 cycles of Rituxan plus Temodar. Subsequently, he was lost to followup.
