A 66-year-old man presented with left limb weakness and ataxia His past medical history included thyroidectomy and gastric ulcer perforation surgery. Cranial MRI disclosed the right frontal lobular surgical remnant and a homogeneous enhanced new lesion in the left frontal parietal lobe with perifocal brain edema. With the suspect of PCNSL (primary central nervous system lymphoma), stereotactic biopsy was performed. Biopsy of the new lesion revealed diffuse large B-cell lymphoma. Therefore, the condition was diagnosed as diffuse large B-cell type PCNSL
Results
Methotrexate and rituximab
Methotrexate is an antimetabolite-targeting folate metabolism and penetrates through cell membranes. Methotrexate given at high doses to penetrate the CNS is the most active single agent against PCNSL. Rituximab improves both overall and progression free survival when combined with methotrexate. Treatment with methotrexate and rituximab provided clinical improvement and nearly complete remission of the lesions on subsequent brain MRI.
