[Two cases of primary intracerebral malignant lymphoma (author's transl)].

Two cases of primary intracerebral malignant lymphoma were reported. Case 1 was a 42-year-old man who had been suffering from headache and mental disturbances for about 3 months prior to admission. These complaints progressed insidiously. He was admitted to our hospital on March 31, 1973. On neurological examinations he was in somnolence state and had neck rigidity, positive of Kernig's sign, disorientation and dyscalculia. Lumbar puncture gave a C.S.F. pressure of 240 mmH2O and the fluid contained 180 mg/dl of protein. A left vertebral angiogram via brachial artery demonstrated thalamic and cerebellar mass lesions. For the development of symptoms of increased intracranial pressure, a ventriculoperitoneal shunt operation was performed on April 7. A right carotid angiogram after ventriculoperitoneal shunt operation disclosed a frontal mass lesion. On May 2, a right frontal craniotomy was carried out and the frontal lobe was removed together with the tumors. After the operation his consciousness remained stupor. Thereafter consciousness and clinical pictures gradually worsened, and he died on May 30. Autopsy was performed, and gross examinations revealed tumors in the bilateral frontal and temporal lobes, right parietal lobe, and left cerebellar hemisphere. On coronal sections, there were neoplastic proliferation extending from the right thalamus to the putamen and a tumor in the right midbrain. No evidence of neoplastic proliferation was found outside the central nervous system. Microscopic examinations showed a diffuse proliferation of tumor cells with mitosis and polymorphism. The tumor was consisted of small lymphoid cells. Reticulin fibers were not found in the tumor with Watanabe's silver method. It was also unable to impregnate the tumor cells with silver carbonate. This case may be classified the primary interacerebral lymphosarcoma. Case 2 was a 48-year-old man, who was admitted to the hospital complaining of occipitalgia, speech disturbances and diffculty in walking. On neurological examinations, he had a right spastic hemiparesis and dyscalculia. A right carotid angiogram showed the frontal mass lesion. On April 18, a left frontal craniotomy was performed and frontal lobe was removed with the tumor. He made a good recovery from the operation and remained well for about 1 month. However, it culminated in a gradual diminution in the level of consciousness. Unfortunately, he died on June 20. No autopsy was performed. Histologically, the tumor cells had round or ovoid nuclei, mitosis and polymorphism. The perivascular arrangement of the tumor tissue showed tendency to confluence. There were reticulin fibers in the tumor tissue, particularly around the blood vessels. Microglial cells were not impregated with silver carbonate. It is supposed that this case belongs to the primary intracerebral "reticulum cells sarcoma-microglioma" described by Rubinstein or reticulum cell sarcoma. Both the case 1 and the case 2 should be filed to be malignant lymphoma in the wide category.