Extensive Central Nervous System Lymphoma Detected at the Time of Diagnosis of Chronic Lymphocytic Leukemia - An Isolated Central Nervous System Richter’s Syndrome: A Case Report

When a central nervous system (CNS) lesion is found in patients with chronic lymphocytic leukemia (CLL), the diagnostic possibilities include CNS involvement of CLL, transformation to large B-cell lymphoma (Richter’s syndrome [RS]), or coincidental presence another tumorous non-tumorous disease. RS commonly occurs preexisting CLL other nodal/extra-nodal involvement, but it extremely rare find isolated concurrently initial diagnosis CLL. A 73-year-old woman presented headache and findings from hospital an elevated white blood cell count intraventricular masses. peripheral smear bone marrow biopsy revealed Brain magnetic resonance imaging gadolinium enhancement showed suprasellar mass pineal within third ventricle, as well extensive leptomeningeal enhancement. Whole-body fluorodeoxyglucose proton emission tomography-computed tomography no hot uptake except for brain lesions. Cerebrospinal fluid cytology small atypical lymphocytes suggestive involvement. However, endoscopic third-ventricle demonstrated diffuse lymphoma. After 3 months systemic high-dose methotrexate, all lesions disappeared, new hemorrhagic masses were right lateral ventricle fourth ventricle. The patient received palliative cranial radiotherapy died 6 after diagnosis. Accurate tissue appropriate treatment are critical.