Primary central nervous system Burkitt lymphoma in a 38-year-old immunocompetent woman: A case report

Abstract

Rationale: Primary central nervous system Burkitt lymphoma (PCNSBL) is a rare and aggressive malignancy, particularly challenging to diagnose in immunocompetent individuals due to its nonspecific presentation.

Patient concerns: A 38-year-old immunocompetent woman presented with a 1-week history of progressively severe headaches in the left frontotemporal region, without systemic symptoms or significant laboratory abnormalities.

Diagnoses: Advanced magnetic resonance imaging revealed a nodular lesion in the left frontal area, initially diagnosed as meningioma. Postsurgical histopathological analysis confirmed the diagnosis of Burkitt lymphoma, characterized by diffuse infiltration of medium-sized lymphocytes, a high MIB1 proliferation index, and Myc gene rearrangement.

Interventions: The patient underwent complete surgical resection of the tumor and a 5-cycle chemotherapy regimen based on high-dose methotrexate, without the need for radiotherapy due to the localized nature of the tumor and complete surgical removal.

Outcomes: Postoperatively, the patient's headaches resolved, and no evidence of tumor recurrence was observed on magnetic resonance imaging after 11 months of follow-up. Additional examinations, including fluorodeoxyglucose-18-positron emission computed tomography, bone marrow biopsy, and cerebrospinal fluid cytology, confirmed the absence of systemic involvement.

Lessons: This case highlights the importance of considering PCNSBL in the differential diagnosis of brain tumors, even in immunocompetent patients. Early diagnosis and a tailored chemotherapy regimen can lead to favorable treatment outcomes, emphasizing the need for a multimodality approach in managing PCNSBL.

Keywords: Burkitt lymphoma; chemotherapy; magnetic resonance imaging; meningioma; primary central nervous system lymphomas.

Figure 1.

(A–C) MRI of the head revealed a nodular lesion located below the skull plate in the left frontal area. The lesion displayed moderate uniform enhancement upon contrast scans, and the adjacent dura mater exhibited thickening and enhancement.

Figure 2.

Histology and immunohistochemistry. (A) Diffuse infiltration of medium-sized lymphocytes, displaying a “starry sky” pattern (H&E staining, ×200 magnification). (B) Positive CD20 expression on tumor cell membranes (×400 magnification). (C) Bcl-6 positivity. (D) Confirmation of Myc gene rearrangement. (E) Bcl-2 positivity. (F) More than 95% of cells exhibited Ki-67 expression (magnification × 400). (G) EBER test negativity. EBER = Epstein–Barr encoding region.

Figure 3.

(A–C) Eleven months after surgery, a follow-up MRI revealed no signs of tumor recurrence.