[Angiotropic lymphoma presenting with subacute dementia: treatment with combination chemotherapy (CHOP) based on antemortem diagnosis--a case report]

We report a 64-year-old male with angiotropic lymphoma. He developed subacute dementia with right hemiparesis. Laboratory abnormalities included elevated serum lactic dehydrogenase (LDH) (715 U/l) erythrocyte sedimentation rate (38 mm/hr) and CSF protein (90 mg/dl). Precontrast MR imaging of the brain demonstrated lesions involving the left internal capsule, subcortical white matter in the right frontal lobe and splenium within the atrophic corpus callosum. A brain biopsy revealed intravascular lymphoid cells, strongly suggestive of angiotropic lymphoma. By combination chemotherapy (CHOP), serum LDH and CSF protein normalized through the patient remained demented. He died of bronchopneumonia about 2 years and 5 months after the onset. Coronal sections of the brain showed infarct in the left internal capsule as well as markedly thin corpus callosum with necrotic lesions involving both the genu and splenium. Microscopic examination showed many small vessels occluded by lymphoma cells (B-lymphocyte) predominantly in the corpus callosum, cerebral white matter, thalamus, midbrain, medulla oblongata, thoracic and lumbar segments of the spinal cord. By combination chemotherapy, our patient survived longer than most of previous patients with angiotropic lymphoma. An early diagnosis and subsequent combination chemotherapy may improve neurological manifestations, and make possible longer survival in angiotropic lymphoma.