Primary leptomeningeal CD30 positive diffuse large B cell lymphoma disguise as meningioma in a young adult: a case report

BACKGROUND

Primary leptomeningeal lymphoma (PLML) without brain parenchymal involvement or systemic disease is very rare, comprising of approximately 7% of all primary central nervous system lymphomas (PCNSL). PLML is a diagnosis of exclusion which should be confirmed on biopsy after ruling out metastasis from systemic lymphomas and dissemination from PCNSL.

CASE DESCRIPTION

A 21-year-old patient presented with the chief complaints of headache, diplopia, decreased vision for five months, and a swelling on the left side of the forehead for four months. On radiology, a large, lobulated, extra-axial mass lesion along the left frontal region with its base towards dura noted. No parenchymal or subependymal CNS lesions were found on CT/MRI. Histopathology was reported as primary leptomeningeal CD30 positive diffuse large B cell lymphoma.

CONCLUSIONS

PLML is a very rare meningeal tumor that requires a very high index of suspicion and is always a diagnosis of exclusion.

Pathophysiology of the Toxic Effects in Metallic Implants

Implants play a very crucial role in modern era of medicine and address several needs in all the medical specialties. Both essential and nonessential metals released from implants at high concentrations can impair biological functions and result in toxicity involving multiple systems of the body. Furthermore, the toxicity information is typically based on exposure through dietary intake and/or occupational/environmental exposure but, since the in vivo implant environment and its composition is different or unknown, individual implants toxic effects needs to be elaborated. Several clinical and nonclinical assessment tools are advised by FDA to evaluate biocompatibility issues, such as risk of immunological response, tissue destruction or overgrowth, and other adverse reactions. The Center for Devices and Radiological Health (CDRH) Biocompatibility Guidelines state that biocompatibility end points caused by metallic implants includes cytotoxicity, sensitization, acute and chronic systemic toxicity, pyrogenicity, genotoxicity, carcinogenicity, implantation, hemocompatibility, reproductive abnormalities, developmental toxicity and biodegradation. Exposure to metal ions which acts as haptens can lead to both local and systemic hypersensitivity reactions which are generally believed to be a Type IV (delayed hypersensitivity) response. Currently, most assessment tools of implant associated hypersensitivity are based on skin sensitization which provides further scopes for research in understanding patient specific immune response causing systemic hypersensitivity.

Extra-Axial supratentorial anaplastic ependymoma: Unusual location of an aggressive tumor, A case report

INTRODUCTION

Ependymomas are more common in the pediatric population, in whom they are commonly infratentorial. Extra axial location of a supratentorial ependymoma is extremely rare.

DIAGNOSIS

Radiologically these tumors are often misdiagnosed as meningioma or other extra axial lesions owing to their unusual location and lack of any pathognomonic features. Hence, histopathological examination becomes imperative for proper evaluation and an adequate diagnosis.

CASE

Herein we report a case of a supratentorial extra axial anaplastic ependymoma misdiagnosed as a metastatic tumor on radiological examination and mimicking meningioma intra operatively, located in the frontal and temporal region in a 20 year old man.

Role of intra-operative squash cytology in rosette-forming glio-neuronal tumor of the fourth ventricle; A case report

Rosette-forming glioneuronal tumor (RGNT) of the 4^th ventricle is a newly described WHO grade I brain tumor included in recent WHO classification of CNS tumors. It is a biphasic tumor thought to originate from pluripotent progenitor cells of subependymal plate. Intra-operative diagnosis plays an important role, as complete surgical excision is the treatment of choice. We are reporting a case of RGNT in a 19 years-old young male emphasizing the intra-operative pathological pointers and their role in accurate diagnosis for the suitable surgical intervention.