Primary malignant lymphoma of the trigeminal region treated with rapid infusion of high-dose MTX and radiation: case report and review of the literature.

Abstract

BACKGROUND:

Extra-axial primary CNS lymphoma, considered rare, mainly arise in the white matter of the brain. Though the tumor responds well to radiation and chemotherapy, the prognosis of primary CNS lymphoma remains poor. We report a case of primary lymphoma of Meckel's cave mimicking a trigeminal schwannoma radiographically, which achieved complete remission through use of rapid high-dose MTX therapy and radiation therapy.

CASE DESCRIPTION:

The patient, a 55-year-old Japanese male, presented left trigeminal neuralgia. Magnetic resonance imaging (MRI) revealed a mass lesion in the left side of Meckel's cave, with extension into the cerebellopontine angle and the infratemporal fossa through the foramen ovale, suggesting trigeminal schwannoma. However, the patient suffered radiologically inexplicable progressive cranial nerve palsy, which suggested malignant disease. MRI and CSF disclosed malignant tumor dissemination; biopsy revealed malignant lymphoma. The treatment, composed of the rapid infusion of high-dose MTX and whole brain and spine radiation, resulted in complete remission.

CONCLUSIONS:

This case, which included atypical presentation of malignant lymphoma, illustrates the importance of including malignant lymphoma in the differential diagnosis of CP-angle and Meckel's cave tumor. The results also confirmed the usefulness of combined rapid high-dose MTX therapy and radiation.

• Authors: Manabu Kinoshita, Shuichi Izumoto, Satoru Oshino, Masahiro Nonaka, Shusuke Moriuchi, Motohiko Maruno, Toshiki Yoshimine
• Journal: Surgical neurology (Surg Neurol) Vol. 60 Issue 4 Pg. 343-8; discussion 348 (Oct 2003) ISSN: 0090-3019 [Print] United States
• PMID: 14505860 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Antimetabolites, Antineoplastic
• Methotrexate

Topics

• Antimetabolites, Antineoplastic (administration & dosage)
• Chemotherapy, Adjuvant
• Cranial Irradiation
• Cranial Nerve Neoplasms (complications, drug therapy, radiotherapy)
• Drug Administration Schedule
• Humans
• Infusions, Intravenous
• Lymphoma (complications, drug therapy, radiotherapy)
• Magnetic Resonance Imaging
• Male
• Methotrexate (administration & dosage)
• Middle Aged
• Radiotherapy, Adjuvant
• Spine (radiation effects)
• Treatment Outcome
• Trigeminal Nerve Diseases (complications, drug therapy, radiotherapy)
• Trigeminal Neuralgia (etiology)