Rare Presentations of Central Nervous System Lymphomas - our Institutional Experience

Rare Presentations of Central Nervous System Lymphomas - our Institutional Experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Rare Presentations of Central Nervous System Lymphomas - our Institutional Experience Thirumurthy K.S., Jayaprakash Duraisamy, Vinoth D, Ananya Ramesh, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9493121/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and importance: Central nervous system (CNS) lymphomas, including primary CNS lymphoma (PCNSL) and primary spinal epidural lymphoma (PSEL), are rare, aggressive forms of non-Hodgkin lymphoma with diverse clinical manifestations. PCNSL typically remains confined to the brain, spinal cord, eyes, and cranial nerves, while secondary CNS lymphoma arises from systemic spread. Diagnostic challenges stem from its ability to mimic other neurological conditions, such as gliomas, metastasis, infections, and demyelinating diseases. Histopathologically, diffuse large B-cell lymphoma predominates, with treatment focusing on high-dose methotrexate-based chemotherapy, often supplemented with rituximab, radiotherapy, or autologous stem cell transplantation. Case presentation: This case series highlights seven rare presentations of CNS lymphomas from our institution, including atypical dural-based lesions, isolated brain involvement mistaken for metastasis or gliomas, and PSEL mimicking spinal tuberculosis. Cases encompassed both pediatric and adult patients, with symptoms ranging from focal neurological deficits and cognitive changes to acute paraplegia. Diagnostic evaluations involved MRI, PET-CT, stereotactic biopsies, and cerebrospinal fluid analysis. Timely biopsies and histopathological confirmation were pivotal in achieving accurate diagnoses. Management strategies varied based on individual case presentations but generally included surgical intervention for decompression, followed by tailored chemotherapy and, in some cases, radiotherapy or bone marrow transplantation. Conclusion: Despite the aggressive nature of these lymphomas, early recognition and multidisciplinary intervention facilitated favorable outcomes. Our experience underscores the need for heightened clinical suspicion and prompt diagnostic workup when encountering atypical neurological presentations to optimize patient prognosis. Primary CNS Lymphoma Primary Spinal epidural Lymphoma Burkitt Lymphoma CNS Diagnostic Pitfalls Rare presentations Single center study Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9493121","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635417533,"identity":"2461b796-2c2e-49ee-aeaa-cb632ee257e0","order_by":0,"name":"Thirumurthy K.S.","email":"","orcid":"","institution":"PSG Institute of Medical Sciences and Research","correspondingAuthor":false,"prefix":"","firstName":"Thirumurthy","middleName":"","lastName":"K.S.","suffix":""},{"id":635417534,"identity":"2c3349cc-6e24-4ec7-bab8-50233b6ad005","order_by":1,"name":"Jayaprakash Duraisamy","email":"","orcid":"","institution":"PSG Institute of Medical Sciences and Research","correspondingAuthor":false,"prefix":"","firstName":"Jayaprakash","middleName":"","lastName":"Duraisamy","suffix":""},{"id":635417535,"identity":"a65b1251-13a2-4215-9474-efa8f11a5259","order_by":2,"name":"Vinoth D","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIiWNgGAWjYDACZiBmbJBgMABxEips6vvBjAICWg7CtDw4k8Y4swGkxYCATQeBqkBqGB+2HWbccAAkhEeLwXHeg48/7rDIM2fvPfggsS2N2fj86sQPDwwY5PnFDmDXcpgv2eDgGYliy55zyQYJ52zYzG683SwBdJjhzNkJWLVINvOYSRxsk0jccCPHTCKhLI3H7MbZDSAtCQa3CWsx/5HAdljCeMbZzT/waeFnRrKFIaHtsIEBf+82vLYAtRgbnG2TKDY4c8ZYIuFMWoLEDd5tFgkGEjj9wsZ/xvBBZVtdnsHxHsOPPypsEvj7z26+CWTI80tj1wIDSLISYLYEXuVoWvgPEFQ9CkbBKBgFIwsAAGSjZTW6PDf7AAAAAElFTkSuQmCC","orcid":"","institution":"PSG Institute of Medical Sciences and Research","correspondingAuthor":true,"prefix":"","firstName":"Vinoth","middleName":"","lastName":"D","suffix":""},{"id":635417536,"identity":"8bea9b59-f5ce-4c39-8fea-ed6168256472","order_by":3,"name":"Ananya Ramesh","email":"","orcid":"","institution":"PSG Institute of Medical Sciences and Research","correspondingAuthor":false,"prefix":"","firstName":"Ananya","middleName":"","lastName":"Ramesh","suffix":""},{"id":635417537,"identity":"372aacd4-dd5f-45e3-858b-a8103a4251c1","order_by":4,"name":"Vidhyalakshmi S","email":"","orcid":"","institution":"PSG Institute of Medical Sciences and Research","correspondingAuthor":false,"prefix":"","firstName":"Vidhyalakshmi","middleName":"","lastName":"S","suffix":""}],"badges":[],"createdAt":"2026-04-22 08:24:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9493121/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9493121/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108786705,"identity":"140968a9-4f29-4844-90f6-f606b1bf05f7","added_by":"auto","created_at":"2026-05-08 11:26:24","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1335976,"visible":true,"origin":"","legend":"","description":"","filename":"FirstUpdatedCNSlymphomachineseneurosurgeryjournalsubmission.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9493121/v1_covered_b02fd4fb-fb1d-4e32-a644-d28f60880418.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rare Presentations of Central Nervous System Lymphomas - our Institutional Experience","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Primary CNS Lymphoma, Primary Spinal epidural Lymphoma, Burkitt Lymphoma CNS, Diagnostic Pitfalls, Rare presentations, Single center study","lastPublishedDoi":"10.21203/rs.3.rs-9493121/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9493121/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and importance:\u003c/strong\u003e\u003cbr\u003e\nCentral nervous system (CNS) lymphomas, including primary CNS lymphoma (PCNSL) and primary spinal epidural lymphoma (PSEL), are rare, aggressive forms of\u003cbr\u003e\nnon-Hodgkin lymphoma with diverse clinical manifestations. PCNSL typically remains confined to the brain, spinal cord, eyes, and cranial nerves, while secondary CNS lymphoma arises from systemic spread. Diagnostic challenges stem from its ability to mimic other neurological conditions, such as gliomas, metastasis, infections, and demyelinating diseases. Histopathologically, diffuse large B-cell lymphoma predominates, with treatment focusing on high-dose methotrexate-based chemotherapy, often supplemented with rituximab, radiotherapy,\u003cbr\u003e\nor autologous stem cell transplantation.\u003cbr\u003e\n \u003cstrong\u003eCase presentation:\u003c/strong\u003e\u003cbr\u003e\nThis case series highlights seven rare presentations of CNS lymphomas from our institution, including atypical dural-based lesions, isolated brain involvement mistaken for metastasis or gliomas, and PSEL mimicking spinal tuberculosis. Cases encompassed both pediatric and adult patients, with symptoms ranging from focal neurological deficits and cognitive changes to acute paraplegia. Diagnostic evaluations involved MRI, PET-CT, stereotactic biopsies, and cerebrospinal fluid analysis. Timely biopsies and histopathological confirmation were pivotal in achieving accurate diagnoses. Management strategies varied based on individual case presentations but generally included surgical intervention for decompression, followed by tailored chemotherapy and, in some cases, radiotherapy or bone marrow transplantation.\u003cbr\u003e\n \u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nDespite the aggressive nature of these lymphomas, early recognition and multidisciplinary intervention facilitated favorable outcomes. Our experience underscores the need for heightened clinical suspicion and prompt diagnostic workup when encountering atypical neurological presentations to optimize patient prognosis.\u003c/p\u003e","manuscriptTitle":"Rare Presentations of Central Nervous System Lymphomas - our Institutional Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-08 11:25:41","doi":"10.21203/rs.3.rs-9493121/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2505e740-61d6-4e0b-b18d-69ff3c01619c","owner":[],"postedDate":"May 8th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-06T10:35:37+00:00","index":51,"fulltext":""},{"type":"reviewerAgreed","content":"106800679933093419565357404474572515043","date":"2026-05-06T09:56:40+00:00","index":50,"fulltext":""},{"type":"reviewersInvited","content":"40","date":"2026-04-30T07:33:45+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T11:25:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-08 11:25:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9493121","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9493121","identity":"rs-9493121","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}