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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A rare case of primary central nervous system lymphoma that regressed spontaneously as shown on serial cranial magnetic resonance imagings (MRI) is described. A 60-year-old woman was admitted to our hospital with a well-enhanced mass lesion in the cerebellum although MRI had demonstrated no abnormal findings 4 months before admission. On admission, She complained of headache, but no neurological deficits were observed. The patient underwent exploratory craniotomy and the tumor was partially removed on February 14. Pathologic examination suspected B-cell type of malignant lymphoma. Postoperative MRI performed on February 23, 2001 showed disappearance of the mass lesion without further treatment. Different polymerase chain reaction (PCR) assays detected clonal immunoglobulin heavy chain gene rearrangements in paraffin-embedded tissues diagnosed as B-cell lymphoma. The patient was discharged without any neurological deficits for two weeks and was followed up on MRI. One year after operation, MRI revealed an abnormal finding in the cerebellum without apparent neurological deterioration. Radiation therapy of the whole brain and the local site was carried out with a total dose of 50Gy. MRI demonstrated complete remission of the tumor following radiation therapy. She was admitted again to our hospital with right hemiparesis on May, 2003. Subsequently, systemic chemotherapy was carried out. The patient died 2 years and 10 months after her initial presentation.
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PMID:[Spontaneous regression of primary central nervous system lymphoma: a case report]. 1535 34

Primary non-Hodgkin's lymphoma of the skull vault is a rare disease. We describe a case occurring in a 72-year-old woman presenting with generalized tonic clonic seizures on a background of a 1-year history of headaches and progressively enlarging scalp masses. Imaging showed diffuse infiltration of the skull vault with multifocal intra- and extracranial soft tissue masses, causing compression and probably infiltration of the cerebral cortex. Further investigation failed to identify any other evidence of systemic lymphoma. Biopsy of one of the scalp masses showed a small to intermediate cell B cell lymphoma. The other nine reported cases of primary skull vault lymphoma are reviewed. The diffuse vault infiltration as well as the multiple intracranial, scalp and temporalis muscle masses renders this case unique.
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PMID:Diffuse primary non-Hodgkin's lymphoma of the cranial vault. 1579 58

A 75-year-old woman presented with intracranial B-cell lymphoma associated with Behcet's disease manifesting as headache and dizziness. She had been treated with prednisolone for 17 years, and colchicine for 4 years under a diagnosis of incomplete Behcet's disease. Computed tomography revealed a 4-cm high density mass surrounded with diffuse edema in the right frontal lobe. Surgery removed a discolored red mass together with hematoma. The histological diagnosis was B-cell type malignant lymphoma. Malignant lymphoma is rarely associated with Behcet's disease, as only 10 cases have been reported.
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PMID:Central nervous system malignant lymphoma associated with Behcet's disease. Case report. 1630 19

Lymphomas, both within and outside the central nervous system, are uncommon among patients with systemic lupus erythematosus (SLE). We describe a 58-year old Korean woman with SLE who presented with acute headache and confusion in the setting of prednisone and mycophenolate mofetil (MMF) therapy used to treat focal proliferative and membranous lupus nephritis. Three-dimensional brain magnetic resonance imaging (MRI) showed two peripherally ('ring') enhancing lesions within the basal ganglia, bilaterally, with associated mass effect and subfalcine herniation. A brain biopsy revealed an Epstein-Barr virus (EBV)-positive diffuse large B cell lymphoma. This is the first description of CNS lymphoma in a patient treated with MMF for lupus nephritis. While intracerebral lymphoma in the immunocompromised patient with lupus is rare, this disorder should be considered in the differential diagnosis of new-onset neurological symptoms among such patients.
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PMID:Central nervous system lymphoma associated with mycophenolate mofetil in lupus nephritis. 1633 85

Primary B cell lymphomas of the skull base are uncommon and lack well-defined treatment guidelines. We report a case of diffuse, large B-cell lymphoma of the cavernous sinus with sphenoid sinus and clivial extension, treated with partial resection, chemotherapy, and proton beam irradiation. To our knowledge, this is the first report of a skull-base lymphoma treated with protons. A 53-year-old female presented with a two-month history of diplopia, persistent headaches, and paresthesia over the left side of her mouth. A skull MRI revealed an enhancing mass in the right cavernous sinus and right sphenoid sinus. Transsphenoidal subtotal resection of the mass confirmed the presence of a diffuse, large B-cell lymphoma. Treatment consisted of CHOP-R chemotherapy and locoregional radiation with protons. Locoregional radiation of the lesion required moderate doses, below the radiation tolerance of adjacent normal structures. Conformal protons were utilized to minimize the volume of normal brain receiving radiation. Conformal proton beam radiotherapy to a moderate dose proved valuable in this case because it minimized the volume of normal brain receiving low to moderate doses of radiation.
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PMID:Locoregional proton radiotherapy of a primary cavernous sinus non-Hodgkin's lymphoma: case report. 1670 Jun 24

A 55-year-old man presented with mist, ptosis, and headache. Repeated imaging studies of the brain showed wandering lesions with small hemorrhage and/or infarct-like change. Leptomeningeal enhancement was noted. Angiography revealed filling defects in dural sinuses, particularly in the left cavernous sinus. Under the diagnosis of dural sinus thrombosis accompanied with rhinitis, antibiotics and anticlotting drugs were administered. Rhinitis was improved, however, the cavernous sinus lesion remained and grew. Autopsy revealed that large B-cell lymphoma occupied the cavernous sinuses and made a mass involving sella turcica, left sphenoid bone, hypophysis. No tumor mass in the brain or tumor dissemination in the leptomeninx was observed. Intima of the brain venous system, however, was widely involved by lymphoma cells admixed with thrombi, which produced occlusion of the leptomeningeal veins and dural sinuses. Various figures of recanalization were also present. It seems that a unique type of thrombosis, i.e. tumoral thrombosis of leptomeningeal veins and dural sinuses, caused by intravascular lymphoma resulted in fatal outcome with multiple brain lesions like hemorrhagic infarct. Recanalization may partly explain transient resolutions of these multiple lesions. It may be suggested that intravascular lymphomatosis can cause marked phlebothrombosis of the brain and can mimic dural sinus thrombosis.
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PMID:[Intravascular lymphomatosis complicated with marked tumoral thrombosis of the brain venous system including dural sinuses. An autopsy case report with 5 months' follow-up and fatal outcome]. 1732 80

A 55-yr-old woman with a history of B-cell lymphoma of the nasopharynx diagnosed in March 1999 eventually underwent submyeloablative allogeneic stem cell transplantation from a sibling donor in December 2002 after conventional treatment options were exhausted. The treatment approach was somewhat altered by the fact that the patient was a practicing Jehovah's Witness and refused blood-blood product transfusion. The course of her treatment was unremarkable until around day 100 posttransplant when she developed graft failure, leading to severe anemia. Blood transfusions were refused. Donor cells were re-infused. During this treatment period, the patient's hemoglobin dropped to a low of 2.7 g/dL, with the patient experiencing severe fatigue, dyspnea on exertion, headaches, and blurred vision. Polymerized human hemoglobin (pyridoxylated) (Poly- Heme, Northfield Laboratories Inc., Evanston, IL) was given under an emergency, compassionate use protocol and successfully bridged the patient's hemoglobin and relieved symptoms during her marrow recovery period.
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PMID:The administration of polymerized human hemoglobin (Pyridoxylated) to a Jehovah's Witness after submyeloablative stem cell transplantation complicated by delayed graft failure. 1743 70

Primary pituitary lymphomas (PPLs) are rare tumors of the central nervous system, and most are of B-cell origin. Extranodal NK/T-cell lymphomas are uncommon neoplasms that are highly aggressive and show a strong association with Epstein-Barr virus. They most commonly affect the nasal cavity and paranasal sinuses; manifestation as a primary pituitary tumor has never been described. The authors report a case of NK/T-cell lymphoma of the pituitary gland and review 17 cases of PPL from the literature. All patients had been evaluated at presentation for clinical, neuroimaging, and histopathological findings. Patients who had systemic lymphoma with secondary involvement of the pituitary gland were excluded. The mean patient age was 55.5 years (range 26-86 years); the male/female ratio was 13:5. The most common presentation was pituitary insufficiency (72%), followed by headache (56%), diplopia (39%), visual loss (28%), and fever (22%). Thirteen patients (72%) exhibited anterior hypopituitarism and seven (39%) had diabetes insipidus at presentation. Magnetic resonance imaging demonstrated enhancing parasellar masses with diffuse enlargement of the pituitary gland (94%), suprasellar extension (44%), cavernous sinus extension (39%), and stalk thickening (22%). Thirteen patients (72%) had B-cell lymphoma, four (22%) had T-cell lymphoma, and one (6%) had NK/T-cell lymphoma. Primary pituitary lymphomas are rare entities with a range of clinical presentations and neuroimaging findings that are unique from those of patients who present with pituitary adenomas. The pathological entity of NK/T-cell lymphoma is distinct, and its course is very aggressive with a poor prognosis.
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PMID:Extranodal NK/T-cell lymphoma presenting as a pituitary mass. Case report and review of the literature. 1788 69

Lymphoma involving the pituitary gland is very rare and usually results from metastatic spread of systemic lymphoma. We present a case of primary central nervous system (CNS) large B cell lymphoma that manifested as pituitary apoplexy. A 45-year-old woman presented with headache, and then rapidly developed a third nerve palsy and bitemporal hemianopsia. Imaging suggested a pituitary macroadenoma, with spontaneous necrosis, extending into the suprasellar region, compressing the optic chiasm and invading the right cavernous sinus. The patient underwent transsphenoidal resection which revealed a vascular, firm tumor. An aggressive decompression of the optic chiasm was performed with complete resolution of both visual fields and third nerve palsy. Final pathology showed B cell lymphoma. Systemic work-up including bone marrow aspiration and CSF studies showed no other foci of lymphoma, and the patient was HIV-negative. Chemotherapy with methotrexate, vincristine, procarbazine, and dexamethasone was administered for primary CNS lymphoma. This is an uncommon diagnosis of which the clinician should be aware in order to tailor surgical intervention and provide early institution of proper therapy.
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PMID:Primary central nervous system lymphoma mimicking pituitary apoplexy: case report. 1820 50

A 51-year-old woman presented with a 2-month history of double vision and numbness around her left ear. She subsequently became unsteady on her feet and developed further cranial nerve abnormalities, before complaining of headache, nausea and vomiting. Imaging revealed features suggestive of two intracranial lesions; one non-contrast-enhancing high-signal area in the cerebellum with associated calcification, and a second contrast-enhancing low-signal area in association with the fourth ventricle, and at surgery there were two apparent components to the tumor. The histopathological features were those of a low-grade, focally calcified tumor comprising atypical ganglion and glial cells with interspersed Rosenthal fibres. Mitotic figures were not seen, and there was no necrosis. An infiltrate of small reactive lymphocytes was interspersed among the neoplastic cells. Immunohistochemistry revealed expression of synaptophysin by many of the dysplastic ganglion cells, with some co-expressing neurofilament protein and occasionally glial fibrillary acidic protein (GFAP). Several of the dysplastic ganglion cells also expressed CD34. The glial cell population was highlighted by GFAP. Ki-67 (MIB-1) activity was not noted among the neoplastic populations--the few positive nuclei in these areas were those of interspersed reactive CD3-positive T lymphocytes. In addition, at the edge of one of the biopsies was a dense infiltrate of mitotically-active large atypical CD 20-positive B lymphocytes, among which the Ki-67 (MIB-1) labeling index reached 80%. The final diagnosis was diffuse large B cell lymphoma arising within a ganglioglioma of the cerebellum, and this is believed to be the first reported case.
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PMID:51-year-old woman with double vision. 1836 42


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