Gastric Lymphoma with Secondary Trigeminal Nerve Lymphoma: A Case Report

Abstract

Data supporting the role of radiotherapy in secondary trigeminal nerve lymphoma is scarce. Here, I report the case of 64-year-old Thai male diagnosed as gastric diffuse large B cell lymphoma with secondary trigeminal nerve lymphoma. He had previously received one cycle of cyclophosphamide, doxorubicin, vincristine, and prednisone
(CHOP), followed by five cycles of rituximab plus CHOP (R-CHOP) with intrathecal methotrexate (MTX) and cytarabine (Ara-C). One month after the last cycle of R-CHOP, he developed a headache and numbness on the left side of his face. MRI revealed thickening of the left trigeminal nerve. He received one intrathecal injection of MTX and Ara-C, followed by systemic chemotherapy. After receiving intrathecal chemotherapy, his symptoms disappeared. Clinical response and MRI studies suggested secondary trigeminal nerve lymphoma. Two months later, our patient’s secondary trigeminal nerve lymphoma had progressed. Salvage whole brain irradiation (36 Gy) with boost dose (50 Gy) along the left trigeminal nerve was given. Unfortunately, our patient developed heart failure and
expired during the radiotherapy session. In conclusion and specific to secondary central nervous system lymphoma (SCNSL), radiotherapy may benefit patients who fail to respond to systemic chemotherapy and palliative treatment. The results this report fail to support the role of radiotherapy in secondary trigeminal nerve lymphoma.