Atypical manifestation of childhood primary cerebral lymphoma restricted to the leptomeninges

Post-traumatic basal ganglia haemorrhage in a child with primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is a rare tumour of childhood with 15-20 cases reported yearly in North America. We present a case of a 13-year-old boy diagnosed with PCNSL who presented more than one-and-a-half years post-treatment with high dose cytosine arabinoside and methotrexate with a right-sided basal ganglia haemorrhage on MRI following a concussion while playing organised football against medical advice. There was no evidence of an underlying vascular malformation or recurrent disease by MRI, cerebrospinal fluid analysis or positron emission tomography computed tomography (PET-CT). However, 6 months post-injury he presented with asymptomatic disease recurrence of the frontal lobe. Our case reports an unusual MRI pattern of post-traumatic injury in a child previously treated for PCNSL that would support a recommendation for the avoidance of contact sports in this population.

Pediatric primary CNS lymphoma: longterm survival after treatment with radiation monotherapy

Primary central nervous system lymphoma (PCNSL) in childhood is very rare. We report a 5-year-old boy who presented with headache and nausea. Magnetic resonance imaging (MRI) showed a faintly enhanced lesion in the left cerebellar hemisphere. MRI-guided biopsy was returned with a histopathological diagnosis of lymphoma. Cranial radiotherapy alone with whole-brain irradiation (30 Gy) followed by a 20-Gy booster to the tumor bed was successful and the patient is alive, well, and in persistent complete remission 14 years post-treatment. This is the only pediatric PCNSL encountered at our institution between 1989 and 2004.

Primary central nervous system lymphoma in children

Primary central nervous system lymphoma (PCNSL) is a very rare brain tumor in children, and the optimal management and prognosis of such patients have yet to be defined. In this study, the incidence rate, clinical features, diagnosis, and treatment of childhood PCNSL are reviewed. Except for human immunodeficiency virus-related PCNSL, the prognosis for patients with this tumor type is significantly better in children than in adults. In the absence of prospective studies, it is very difficult to determine the true incidence and the best therapeutic strategy for this rare entity. The majority of children with PCNSL, however, can achieve long-term remissions with intensive chemotherapy alone (an estimated 70% 5-year event-free survival rate), and cranial irradiation can be reserved for relapse of the disease. Further progress in the management of childhood PCNSL will require prospective multinational studies.