Primary Central Nervous System Post-transplant Lymphoproliferative Disorder Misdiagnosed as Glioblastoma: A Case Report.

BACKGROUND/AIM: Post-transplant lymphoproliferative disorder (PTLD) is a heterogeneous lymphoid cell disorder that occurs after solid organ and hematopoietic stem cell transplantation. Primary occurrence in the central nervous system PTLD (PCNS PTLD) is rare. We present a rare case of PCNS-PTLD misdiagnosed as glioblastoma (GBM).

CASE REPORT: A 62-year-old man underwent living-related kidney transplantation at the age of 49. He was introduced to our Department because of transient speech disturbance. Computed tomography scan of the head showed a mass at the right frontal lobe. Magnetic resonance imaging (MRI) of the head showed a ring-enhancing lesion with a small, homonymous enhanced lesion in the right frontal lobe, invading the corpus callosum. Because the pathological analysis of an intraoperative frozen section of the tumour indicated high-grade glioma, the tumour was completely resected and BCNU wafers were implanted at the resection site. However, postoperative pathological analysis indicated a diffuse large, CD20 positive B-cell lymphoma. In addition, the patient was positive for Epstein Barr virus-encoded small RNA, and therefore, diagnosis of PCNS PTLD was confirmed. The dose of the immunosuppressant therapy was reduced, and rituximab monotherapy was begun.

CONCLUSION

Both imaging and pathological findings on intraoperative frozen section of PCNS PTLD are similar to those of GBM. Therefore, in such cases, surgeons should consider PCNS-PTLD when the diagnosis indicates GBM.