Abstract
A 37-year-old Hispanic man with a right atrial intracardiac mass diagnosed as diffuse large B-cell lymphoma (DLBCL) was successfully treated with surgery and chemotherapy. During 4 years, several total-body positron emission tomography and MRI scans showed no extracardiac lymphoma. On year 5 after the cardiac surgery, patient presented with sleepiness, hyperphagia, memory loss, confabulation, dementia and diabetes insipidus. Brain MRI showed a single hypothalamic recurrence of the original lymphoma that responded to high-dose methotrexate treatment. Correction of diabetes insipidus improved alertness but amnesia and cognitive deficits persisted, including incapacity to read and write. This case illustrates two unusual locations of DLBCL: Primary cardiac lymphoma and hypothalamus. We emphasise the importance of third ventricle tumours as causing amnesia, confabulation, behavioural changes, alexia-agraphia, endocrine disorders and alterations of the circadian rhythm of wakefulness-sleep secondary to lesions of specific hypothalamic nuclei and disruption of hypothalamic-thalamic circuits.
Original language | English (US) |
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Article number | 217700 |
Journal | BMJ Case Reports |
Volume | 2018 |
DOIs | |
State | Published - Aug 27 2018 |
Keywords
- cancer intervention
- memory disorders
- neuroendocrinology
- neurooncology
- sleep disorders (neurology)
- Neoplasm Recurrence, Local/diagnostic imaging
- Humans
- Antimetabolites, Antineoplastic/therapeutic use
- Heart Neoplasms/diagnostic imaging
- Male
- Treatment Outcome
- Hyperphagia/etiology
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Positron Emission Tomography Computed Tomography
- Third Ventricle/diagnostic imaging
- Magnetic Resonance Imaging
- Memory Disorders/etiology
- Adult
- Cerebral Ventricle Neoplasms/complications
- Diabetes Insipidus/etiology
- Methotrexate/therapeutic use
ASJC Scopus subject areas
- General Medicine