Primary central nervous system lymphoma in immunocompetent patient: A case report
DOI:
https://doi.org/10.5281/zenodo.11397215Keywords:
Non Hodgkin Central Nervous System Neoplasms, Lymphoma, Linfoma no HodgkinAbstract
Introducción: el linfoma primario del sistema nervioso central (LPSNC) es una neoplasia linfoide extranodal que afecta el cerebro, médula espinal, leptomeninges o espacio vítreo-retina, sin involucro sistémico. Representa el 3% de tumores del SNC predominantemente en el contexto de inmunosupresión (infección por VIH, post-trasplantados). Tienen una presentación clínica y radiológica inespecífica por lo que representan un reto diagnóstico sobre todo en pacientes inmunocompetentes. Su pronóstico es desfavorable a pesar de la alta respuesta al tratamiento inicial.
Caso clínico: hombre de 69 años, hospitalizado por un síndrome de motoneurona superior e hipertensión intracraneal. Presentó estudios de laboratorio sin alteraciones y una tomografía de cráneo con lesiones múltiples captantes de contraste con edema vasogénico. Los estudios de extensión en búsqueda de un tumor primario fueron negativos. La resonancia magnética demostró lesiones compatibles con un linfoma. Se realizó un PET/CT con 18-fluorodesoxiglucosa que descartó afectación a nivel sistémico y una biopsia cerebral que confirmó un LPSNC de tipo linfoma difuso de células grandes B. El paciente fue referido a un centro hospitalario de tercer nivel para quimioterapia, cumpliendo dos ciclos de metotrexato a altas dosis más rituximab sin respuesta y desenlace fatal.
Conclusiones: el LPSNC es un tipo de linfoma extranodal agresivo, de baja incidencia, el cual debe ser considerado en pacientes inmunocompetentes mayores a 60 años con múltiples lesiones cerebrales con la finalidad de iniciar tratamiento de forma oportuna.
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