Abstract

N’chiepo Kouadio Davy*, Seka Evrad Narcisse, Tbouda Mohammed, Agbanglanon Douhoue Patricia, Kietga Gael, Houessou Oswald, Elkacemi Hanane, Elmajjaoui Saana, Kebdani Tayeb and Benjaafar Noureddine

ABSTRACT

Primary central nervous system lymphoma (PCNSL) is a very uncommon cancer and rare subtype of extranodal, non-Hodgkin’s lymphoma invading structures of the central nervous system (CNS). We report three cases of PCNSL, treated at the radiotherapy department of the National Oncology’s Institute of Rabat (INO). All our patients are immunocompetent, and the average age is 33 years (range 25 - 42 years). The main reasons that our patients come to clinical attention were hemiparesis, elevated intracranial pressure, seizures, and dizziness. MRI at the diagnosis revealed unique lesion localized to the cerebral hemispheres, in particular to the parietal (2 cases) and fronto-parietal (1 case) with contrast enhancement founded and perifocal edema and mass effect on the ventricular structures. After stereotaxic biopsy, immunochemistry analysis confirmed diffuse large B-cell NHL (figures 2 and 3), with positivity of CD20 (figure 4), BCL2 (2 cases) and with very high proliferative activity index Ki67 of 40-70% (figure 5) and CD10 (1 case) was positive (figure 6). The extension workup showed that the lymphoma was strictly cerebral in all patients. Patients were RPA class I (MSKCC score) or group I (IELSG score). The treatment consisted of combination of chemotherapy and radiotherapy. All patients received 5 courses of HD-MTX. Two patients which achieved complete remission received WBRT of 40 Gy and 45 Gy. One patient had a partial response and underwent 60 Gy in total dose (WBRT of 40 Gy with a boost of 20 Gy on the residual tumor). After a median follow-up of 65 months (range 38 to 95months), the 3 patients remained in complete remission without signs of relapse and without side effects.