{"id":"f0dfd857-cbe3-4ed7-b041-49e1342ca5fc","slug":"immunocompetent-patient-with-isolated-primary-fourth-ventricle-lymphoma-unusual-diagnosis-their-pitfalls-and-challenges","title":"Immunocompetent patient with isolated primary fourth ventricle lymphoma. Unusual diagnosis, their pitfalls, and challenges","authors":["Tiago S. F. Holanda","Isnara Mara Freitas Pimentel","Gabriela Oliveira Gosch","Daniel Gurgel Fernandes Tavora","Luiz Anderson Bevilaqua Bandeira","Flavio Leitao Filho"],"abstract":"Background: Primary central nervous system lymphoma (PCNSL) is an uncommon lesion and represent 4% of all central nervous system (CNS) cancers. There have been few reports of localized isolated lymphoma developing in the fourth ventricle, with only 8 previous cases described. We present a case of an immunocompetent patient with isolated fourth ventricle lymphoma who did not have diffusion-weighted imaging (DWI) restriction. Case Description: A 45-year-old man presented a history of headache, vomiting and weigh loss. Upon clinical examination, he presented bilateral papilledema, multidirectional nystagmus, and gait imbalance. Magnetic resonance imaging showed a solid tumor in fourth ventricle with 1.8 × 1.6 × 1.1 cm. The patient was submitted to a suboccipital telovelar approach. The pathological study showed a neoplasm composed of loose round cells. Immunohistochemistry showed positivity for CD-45 and CD-23. The diagnosis of primary CNS lymphoma of the fourth ventricle was certified. Patient was sent to complementary treatment with hematologist and radiotherapy and chemotherapy were started. Conclusion: PCNSL is a rare and aggressive pathology with high rates of mortality and recurrence. It requires a multidisciplinary team and multiple therapies to control the disease and deliver better quality of life and prognosis to the patient.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/f0dfd857-cbe3-4ed7-b041-49e1342ca5fc/featured/hero-1781560859022.png","publishDate":"2022-10-14T00:00:00.000Z","doi":"10.25259/SNI_584_2022","categories":["Neuro-oncology","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/10/11935/SNI-13-463.pdf"}