Primary central nervous system cytotoxic/suppressor T-cell lymphoma - Report of a unique case and review of the literature

Peripheral T-cell lymphoma primary to the central nervous stem is a rare occurrence. The authors report a case of an 89-year-old woman who presented with a 3-month history of worsening confusion and recent onset of headache, nausea and vomiting. and upper limb tremors. Computed tomograph and magnetic resonance imaging examinations demonstrated a 4.5-cm solitary brain mass fit the right basal ganglia with compression along the ventricular system, No other lesion was found fit the patient. Histologic and immunohistochemical studies of a stereotactic biopsy of the mass showed a T-cell lymphoproliferative lesion positive for CD3, CD8. CD57. and T-cell intracellular antigen 1 and negative for CD4. CD56. CD30, anaplastic lymphoma kinase, and CD20. A monoclonal T-cell receptor-gamma gene rearrangement was detected by polymerase chain reaction analysis of genomic DNA isolated from paraffin-em bedded tumor tissue sections. These findings were consistent with peripheral T-cell lymphoma of cytotoxic/suppressor phenotype, resembling the phenotype of T-cell large granular cell leukemia. To the authors' best knowledge, this represents the first reported case of primary brain T-cell lymphoma with a cytotoxic/suppressor immunophenotype. A brief review of the literature of primary brain T-cell lymphoma is also presented.