Primary Central Nervous System Lymphoma Presenting as a Solitary Fourth Ventricular Mass: A Case Report

TL;DR

A rare case of brain lymphoma in the fourth ventricle was successfully treated with surgery and chemotherapy, highlighting the need for early diagnosis.

Contribution

This case report documents a rare presentation of primary central nervous system lymphoma in the fourth ventricle.

Findings

A 30-year-old male was diagnosed with primary central nervous system lymphoma in the fourth ventricle.

Complete resection and MTR chemotherapy led to four months of disease-free follow-up.

Lymphoma should be considered in the differential diagnosis for fourth ventricle lesions with rapid progression.

Abstract

The occurrence of primary fourth ventricular lymphoma is an exceptionally uncommon phenomenon. Here, we present a case of lymphoma in the fourth ventricle in a 30-year-old male who presented with progressive headache and vertigo over the last one month of his presentation. Preoperative MRI revealed a space-occupying lesion of the fourth ventricle. Pathological analysis following complete resection confirmed the lesion as primary central nervous system lymphoma. The patient underwent chemotherapy following the MTR (methotrexate, temozolomide, and rituximab) protocol with four months of uneventful follow-up, indicating no disease recurrence. Therefore, clinicians are advised to consider the potential presence of lymphoma as part of the differential diagnosis for space-occupying lesions, especially when there is a combination of clinical deterioration and rapid imaging progression.

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