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A Case of Metastatic Peripheral T-cell Lymphoma of the Central Nervous System During the Perinatal Period Hirotake EDA 1 , Takeshi MIYAZAKI 1 , Chie OONISHI 2 , Shingo MITAKI 3 , Fumio NAKAGAWA 1 , Shinya HAGIWARA 1 , Hidemasa NAGAI 1 , Yasuhiko AKIYAMA 1 1Department of Neurosurgery, Shimane University Faculty of Medicine 2Department of Oncology/Hematology, Shimane University Faculty of Medicine 3Department of Neurology, Shimane University Faculty of Medicine Keyword: peripheral T-cell lymphoma , perinatal period , central nervous system , Epstein-Barr virus pp.559-563
Published Date 2019/5/10
DOI https://doi.org/10.11477/mf.1436203981
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 The diagnosis of malignant tumors during pregnancy is not uncommon;the incidence is one per six thousand pregnancies. However, the diagnosis of malignant lymphoma—especially T-cell lymphoma—during pregnancy is extremely rare. Thus, the early detection and management of T-cell lymphoma necessitates difficult decision-making.

 A 30-year-old woman developed consciousness disturbance on postpartum day three. Because brain MRI showed multiple edematous lesions in both hemispheres, vasculitis or encephalitis was initially suspected, and diagnostic therapy was initiated with the administration of steroids. One month later, the patient suddenly developed a subarachnoid hemorrhage followed by acute hydrocephalus. Emergent ventricular drainage and lesion biopsy were simultaneously performed. Based on the findings, the patient was diagnosed with peripheral T-cell lymphoma not otherwise specified(PTCL-NOS). Laboratory findings indicated Epstein-Barr virus(EBV)infection. Moreover, the same diagnosis was supported by breast and bone marrow biopsies. Thus, the brain lesions were presumed to be metastatic in nature. The prognosis of PTCL-NOS is severely poor in pregnant women as diagnosis is delayed owing to limitations of radiological examinations and because symptoms can be confused with those of other diseases or hyperemesis gravidarum. Additionally, the alteration of immunotolerance in association with pregnancy and EBV infection might have influenced the aggressive features of this case. When a pregnant woman presents with neurological symptoms, malignant lymphoma should be considered when making a differential diagnosis.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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