Primary CNS lymphoma in an immunocompetent patient: an unusual case illustrating the usual problems facing brain tumour management in a lower-middle-income country

Ashraf, M. , Farooq, M., Ahmad Malik, M., Ali, S., Sohail, S., Shahzad Hussain, S. and Ashraf, N. (2022) Primary CNS lymphoma in an immunocompetent patient: an unusual case illustrating the usual problems facing brain tumour management in a lower-middle-income country. Pakistan Journal Of Neurological Surgery, 26(4), pp. 687-692. (doi: 10.36552/pjns.v26i4.680)

Abstract

Primary central nervous system lymphoma (PCNSL) is a rare extra-nodal non-Hodgkin lymphoma (NHL). It primarily affects the immunocompromised but is rarely seen in immunocompetent individuals. The pitfalls in the healthcare system of lower-middle-income countries produce many obstacles, impeding timely diagnosis, timely treatment, and optimal quality of care. A 57-year-old immunocompetent, diabetic female presented with progressive generalised fatiguability, forgetfulness, and subtle behavioural changes for the last one and a half years. MRI revealed an area of gyri from dense post-contrast enhancement in the right posterior parietal region. Her symptoms kept aggravating with periods of partial remission as steroids were being administered. Reasons for delays in diagnosis and hence timely treatment include lack of primary care referral, conflicting neurosurgical opinion, and absence of multidisciplinary team management. A right posterior parietal parasagittal craniotomy was performed to excise the lesion. The patient was subsequently referred for adjuvant therapy. We use our patient's clinical journey to exemplify the structural barriers to providing optimal and timely care for brain tumour patients in a developing country. Primary CNS Lymphomas in immunocompetent patients are rare. Poor infrastructure and referral pathways contribute to delayed diagnosis. Lack of multi-disciplinary care owing to organisational issues is a major problem faced by brain tumour patients in a lower-middle-income country like ours. Brain tumour management requires a specialist multidisciplinary team approach to ensure timely diagnosis and optimal treatment

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ashraf, Dr Mohammad
• Authors: Ashraf, M., Farooq, M., Ahmad Malik, M., Ali, S., Sohail, S., Shahzad Hussain, S., and Ashraf, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Pakistan Journal Of Neurological Surgery
• Publisher: Pakistan Society of Neurosurgeons
• ISSN: 1995-8811
• Published Online: 31 December 2022
• Copyright Holders: Copyright © 2023 Pakistan Journal Of Neurological Surgery
• First Published: First published in Pakistan Journal Of Neurological Surgery 26(4):687-692
• Publisher Policy: Reproduced under a Creative Commons license