Cerebrospinal fluid cytology-assisted diagnosis of T-lymphoblastic lymphoma: A case report

Lymphoblastic lymphoma is a rare form of highly aggressive non-Hodgkin lymphoma. The most common clinical manifestations are superficial lymphadenopathy and mediastinal mass. In a few cases, invasion of the central nervous system is the first manifestation. It is also difficult to diagnose patients using the central nervous system as the first manifestation. Here, we report the case of a 26-year-old man with central nervous system disease as the primary manifestation; we used cerebrospinal fluid cytology (CSF-C) for early diagnosis and shared the importance of CSF-C for early diagnosis of T-cell lymphoblastic lymphoma. The patient was admitted to the hospital because of “right eyelid closure weakness with headache for 1 month and exacerbation with sluggish response for 1 week.” Physical examination revealed a bilateral Kernig sign (+) and Lasgue sign (+). The Mini-Mental State Examination and Montreal Cognitive Assessment scores were 20 (out of 30). When there was no abnormality in the imaging examination, the patient was misdiagnosed with meningoencephalitis and received anti-inflammatory treatment because the initial symptom was a clinical manifestation of the central nervous system, and the imaging and blood tests showed no definite abnormality. Cerebrospinal fluid has been studied and second-generation sequencing detection, such as after CSF-C tip to abnormal lymphocytes, to open the breakthrough of the diagnosis of lymphoma. In the cases with central nervous system injury as the first manifestation, CSF-C was combined with immunohistochemistry and cerebrospinal fluid flow cytometry to provide a clear and effective method and evidence for the early diagnosis of T-cell lymphoblastic lymphoma.