SECONDARY CENTRAL NERVOUS SYSTEM DAMAGE IN PRIMARY MEDIASTINAL (THYMIC) B-LARGE CELL LYMPHOMA (CLINICAL OBSERVATION)
THE AIM OF THE STUDY was to describe the clinical observation of metastatic (secondary) lesions of the central nervous system (CNS) in primary mediastinal (thymic) B-large cell lymphoma (PMVCL). MATERIAL AND METHODS. The patient was treated in the neurosurgery department of the Mariinsky City Hospital in St. Petersburg. Her full diagnosis was composed of primary mediastinal (thymic) B-large cell lymphoma (PMVKL) with massive damage to the mediastinum, lung tissue, axillary lymph nodes on the right, spleen, kidneys, adrenal glands, retroperitoneal patients. lymph nodes, right ovary, stage IV B, combined treatment (6 courses of PCT according to the R-EPOCH scheme, a course of remote radiation therapy (3D CRT) - stage 1 - cervical-supraclavicular region on the left, initially affected mediastinal lymph nodes, sternum, soft tissues of the anterior chest wall, stage 2 - locally to the residual conglomerate in the retrosternal zone) Metastatic damage to the substance, membranes of the brain with extracranial spread. The patient was taken to a hospital with suspected head injury. MSCT, MRI of the brain with contrast enhancement were performed and additional MR sequences were included in the study protocol: contrast MR perfusion (PWI), diffusion-tensor imaging (tractography (DTI), spectroscopy (MRS). Volumetric formations were found in the projection of the parietal lobe) with intra- and extra-cerebral parasagittal localization with destruction of the right parietal bone. Taking into consideration the medical history and signal characteristics, the metastatic nature of the changes in MRI and MSCT from mediastinal lymph was suspected. RESULTS. The extracranial part of the volumetric formation in the right parasagittal parietal region was removed in order to verify the structure of the tumor. The performed immunohistochemical study confirmed metastatic (secondary) damage to the central nervous system (HSCV) of primary mediastinal (thymic) B-large cell lymphoma.