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Primary central nervous system lymphoma mimicking recurrent depressive disorder: A case report.

Liu W, Xue J, Yu S, Chen Q, Li X, Yu R - Oncol Lett (2015)

Bottom Line: The current study reports the case of a PCNSL patient with a history of major depressive disorder and coexisting rheumatoid arthritis (treated with methotrexate), who initially presented with recurrent depressive disorder that showed no response to antidepressant drug therapy.Magnetic resonance imaging revealed multiple mass lesions in the brain, and pathological examination of the biopsy confirmed the diagnosis of diffuse large B cell lymphoma of the central nervous system.The present case demonstrated that PCNSL may affect mood in the early stages of the disease and thus, clinicians must be aware of this manifestation in patients with depressive disorder co-existing with immunosuppressive conditions, as early detection and appropriate treatment are important prognostic factors for PCNSL.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.

ABSTRACT

Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma, which is limited to the central nervous system. Few studies are available reporting psychiatric symptoms as the initial and dominant presentation of PCNSL. The current study reports the case of a PCNSL patient with a history of major depressive disorder and coexisting rheumatoid arthritis (treated with methotrexate), who initially presented with recurrent depressive disorder that showed no response to antidepressant drug therapy. Magnetic resonance imaging revealed multiple mass lesions in the brain, and pathological examination of the biopsy confirmed the diagnosis of diffuse large B cell lymphoma of the central nervous system. The present case demonstrated that PCNSL may affect mood in the early stages of the disease and thus, clinicians must be aware of this manifestation in patients with depressive disorder co-existing with immunosuppressive conditions, as early detection and appropriate treatment are important prognostic factors for PCNSL.

No MeSH data available.


Related in: MedlinePlus

Immunohistochemical staining of the brain-biopsy specimen. (A) Diffuse atypical large lymphocytic tumor cells are visible, with penetration into and through the vessel wall (H&E staining, magnification ×200). (B) CD20 staining reveals diffuse and strong cytoplamic staining (magnification, ×100).
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f2-ol-09-04-1819: Immunohistochemical staining of the brain-biopsy specimen. (A) Diffuse atypical large lymphocytic tumor cells are visible, with penetration into and through the vessel wall (H&E staining, magnification ×200). (B) CD20 staining reveals diffuse and strong cytoplamic staining (magnification, ×100).

Mentions: These findings indicated the presence of brain tumors, and the patient was transferred to the inpatient neurosurgical service. Fluoxetine treatment was discontinued, and a craniotomy was conducted for open biopsy and resection of the temporal lobe lesion. A pathological examination of the biopsy specimen confirmed the diagnosis of diffuse large B cell lymphoma, and immunohistochemical staining revealed that the tumor cells were positive for CD20 and bcl-6 and negative for CD3 and Epstein-Barr virus (EBV)-EBV-encoded non-polyadenylated RNA (Fig. 2). A positron emission tomography scan was negative for systemic lymphoma, and a slit lamp examination revealed no evidence of ocular lymphoma. Therefore, a final diagnosis of PCNSL was determined. The patient received whole brain radiotherapy (45 Gy total, administered in 21 fractions, five times a week) following surgery. During the one year follow-up, no clinical or radiographic evidence of PCNSL recurrence was observed, and the patient’s mental state was stable without antidepressant therapy. No recurrence or worsening of MDD has been observed to date.


Primary central nervous system lymphoma mimicking recurrent depressive disorder: A case report.

Liu W, Xue J, Yu S, Chen Q, Li X, Yu R - Oncol Lett (2015)

Immunohistochemical staining of the brain-biopsy specimen. (A) Diffuse atypical large lymphocytic tumor cells are visible, with penetration into and through the vessel wall (H&E staining, magnification ×200). (B) CD20 staining reveals diffuse and strong cytoplamic staining (magnification, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356351&req=5

f2-ol-09-04-1819: Immunohistochemical staining of the brain-biopsy specimen. (A) Diffuse atypical large lymphocytic tumor cells are visible, with penetration into and through the vessel wall (H&E staining, magnification ×200). (B) CD20 staining reveals diffuse and strong cytoplamic staining (magnification, ×100).
Mentions: These findings indicated the presence of brain tumors, and the patient was transferred to the inpatient neurosurgical service. Fluoxetine treatment was discontinued, and a craniotomy was conducted for open biopsy and resection of the temporal lobe lesion. A pathological examination of the biopsy specimen confirmed the diagnosis of diffuse large B cell lymphoma, and immunohistochemical staining revealed that the tumor cells were positive for CD20 and bcl-6 and negative for CD3 and Epstein-Barr virus (EBV)-EBV-encoded non-polyadenylated RNA (Fig. 2). A positron emission tomography scan was negative for systemic lymphoma, and a slit lamp examination revealed no evidence of ocular lymphoma. Therefore, a final diagnosis of PCNSL was determined. The patient received whole brain radiotherapy (45 Gy total, administered in 21 fractions, five times a week) following surgery. During the one year follow-up, no clinical or radiographic evidence of PCNSL recurrence was observed, and the patient’s mental state was stable without antidepressant therapy. No recurrence or worsening of MDD has been observed to date.

Bottom Line: The current study reports the case of a PCNSL patient with a history of major depressive disorder and coexisting rheumatoid arthritis (treated with methotrexate), who initially presented with recurrent depressive disorder that showed no response to antidepressant drug therapy.Magnetic resonance imaging revealed multiple mass lesions in the brain, and pathological examination of the biopsy confirmed the diagnosis of diffuse large B cell lymphoma of the central nervous system.The present case demonstrated that PCNSL may affect mood in the early stages of the disease and thus, clinicians must be aware of this manifestation in patients with depressive disorder co-existing with immunosuppressive conditions, as early detection and appropriate treatment are important prognostic factors for PCNSL.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.

ABSTRACT

Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma, which is limited to the central nervous system. Few studies are available reporting psychiatric symptoms as the initial and dominant presentation of PCNSL. The current study reports the case of a PCNSL patient with a history of major depressive disorder and coexisting rheumatoid arthritis (treated with methotrexate), who initially presented with recurrent depressive disorder that showed no response to antidepressant drug therapy. Magnetic resonance imaging revealed multiple mass lesions in the brain, and pathological examination of the biopsy confirmed the diagnosis of diffuse large B cell lymphoma of the central nervous system. The present case demonstrated that PCNSL may affect mood in the early stages of the disease and thus, clinicians must be aware of this manifestation in patients with depressive disorder co-existing with immunosuppressive conditions, as early detection and appropriate treatment are important prognostic factors for PCNSL.

No MeSH data available.


Related in: MedlinePlus