An autopsy case of primary malignant T-cell lymphoma of the central nervous system of a 71-year-old female is presented. The patient was admitted with a diagnosis of brain tumor in December 1985 with a 10-day history of motor weakness of the lower extremities, tendency of somnolence, and urinary incontinence. Neurological findings on admission revealed left hemiparesis, action tremor and Babinski's sign.
However, her general physical examination was unremarkable. A computed tomography [CT] scan without contrast medium, demonstrated isodensity lesions in the right deep frontal lobe extending into the left deep frontal and the right parietal lobes. After the injection of contrast medium, these lesions were homogeneously enhanced. Carotid angiography revealed an avascular space-occupying mass in the right deep frontal lobe. The patient was treated with surgical removal of a right deep frontal tumor followed by combined radiotherapy [a total of 43 Gy] and chemotherapy. Most of the tumor disappeared during radiotherapy [20 Gy] on the CT scan. Following repetitive episodes of remission and exacerbation, the patient expired about 9 months after the onset of symptoms.
The biopsy materials obtained from surgery disclosed diffuse infiltration of large lymphoma cells. Most of lymphoma cells had large, round, clear nuclei with a few irregularly situated nucleoli. Frequently, neoplastic giant cells with bizarre convoluted or lobulated nuclei were found. In immunohistochemical study, some of the lymphoma cells had T-cell markers, such as CD4, CD8 and MT-1. These positive cells had large and convoluted or lobulated nuclei. None of lymphoma cells demonstrated the presence of cytoplasmic immunogloblins of IgG, IgA, IgM, kappa chain and lamda chain, as well as MB-1. Neither glial fibrillary acidic protein [GFAP] nor neuron specific enolase[NSF] were reactive with the lymphoma cells.
At post-mortem examination, the patient had secondary tumors of different type: Grawitz tumor, benign renal cortical adenoma and thyroid multiple adenomas. The occurrence of multiple primary tumor [polyoncogenesis] in the present case appears to be evidence favoring the concept of the loss of immunological surveillance against neoplasms.
