Abstract
Background: Primary central nervous system lymphoma （PCNSL） occurs locally in the central nervous system （CNS）and accounts for less than 1% of all malignant lymphomas. Malignant lymphoma derived from other organs is rarely infiltrated into the CNS at the time of initial detection. We present a rare case of malignant lymphoma coexisting in the left mandible and the left temporal lobe at the initial detection.
Case Presentation: The case was a 64-year-old female with a symptomatic mass in the left mandible and hypoesthesia of the lower lip. As a left temporal lobe mass had been pointed out in a brain checkup two months earlier, it was planned to be examined. At the initial examination, a mass of elastic hardness and normal mucosa color was found in the buccal gingiva ranging from the left lower jaw canine to the molar teeth. CT and MRI showed a 50-mm large lesion with osteolytic change in the left mandibular bone. As a result of mandible mass biopsy, it was diagnosed as diffuse large B-cell lymphoma. To determine the treatment strategy, brain mass biopsy was performed by a neurosurgeon, and B-cell lymphoma was diagnosed as well. R-MPV therapy was immediately performed, resulting in complete response. After achieving remission, open reduction and internal fixation were performed on the pathological fracture of the mandible that occurred during R-MPV. Two months later, the left temporal lobe tumor relapsed. Although she received salvage chemotherapy, she died five months after the relapse.
Conclusion: PCNSL is a rare malignant lymphoma. To our knowledge, this is the first report in the literature of the simultaneous appearance of PCNSL and mandible DLBCL. ORIF was performed on the pathological fracture of the mandible that occurred during R-MPV. Fixation failure was not observed during the clinical course, and the patient’s QOL was maintained.
