Microscopic biopsy after unsuccessful endoscopic biopsy for primary central nervous system lymphoma of the corpus callosum: A case report. (September 2021)

• Record Type: Journal Article
• Authors: Kanazawa, Tokunori; Karatsu, Kosuke; Kuramae, Takumi; Ishihara, Masayuki
• Is Part Of: Annals of medicine and surgery. Volume 69(2021)
• Publication Date: 2021-09
• Subjects: PCNSL -- Endoscopic biopsy -- Microscopic biopsy -- 5-ALA -- Neuronavigation; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.102746
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction and importance: Primary central nervous system lymphoma (PCNSL) is a rare tumor with a poor prognosis. Early brain biopsy is essential to avoid a diagnostic delay. To date, reports of successful diagnosis for PCNSL of the corpus callosum by endoscopic biopsy are rare. Case presentation: Herein, we report the case of an elderly woman with PCNSL of the corpus callosum who initially presented with rapidly progressive dementia. The condition was finally diagnosed by microscopic biopsy after unsuccessful endoscopic biopsy. Moreover, the postoperative course was uneventful. She is currently receiving systemic chemotherapy. Clinical discussion: Early diagnosis and subsequent systemic chemotherapy with or without whole brain radiotherapy are critical for PCNSL. Endoscopic biopsy may be a diagnostic option for suspected PCNSL, although stereotactic needle biopsy is most commonly used. Conclusion: Utilizing neuronavigation and 5-aminolevulinic acid (ALA) fluorescence guidance could be helpful in identifying lesions insufficiently exposed by endoscopic visualization. However, cerebrospinal fluid (CSF) loss due to the endoscopic approach through the ventricle might be a cause of neuronavigation misregistration. Highlights: Reports of the successful diagnosis of PCNSL by endoscopic biopsy are rare. However, endoscopic biopsy may be a diagnostic choice for suspected PCNSL. Neuronavigation and 5-ALA fluorescence guidance could be helpful. CSF loss may be a cause of neuronavigation misregistration as with this case.