Case Report Turk Neurosurg 2015, Vol: 25, No: 5, 796-800 796 Received: 05.02.2014 / Accepted: 17.04.2014 DOI: 10.5137/1019-5149.JTN.10594-14.1 5-Aminolevulinic Acid-Induced Fluorescence in Cerebellar Primary Central Nervous System Lymphoma: A Case Report and Literature Review Serebellar Yerleşimli Primer Santral Sinir Sistemi Lenfomasında 5-Aminolevülinik Asit ile İndüklenmiş Floresans: Olgu Sunumu ve Literatür Derlemesi Junkoh YAMAMOTO, Takehiro KITAGAWA, Daisuke AKIBA, Shigeru NISHIZAWA University of Occupational and Environmental Health, Department of Neurosurgery, Kitakyushu, Japan Corresponding Author: Junkoh YAMAMOTO / E-mail: yama9218@med.uoeh-u.ac.jp ABSTRACT 5-Aminolevulinic acid (5-ALA)-induced fuorescence-guided resection is a widely used procedure for patients with malignant gliomas. However, the clinical application of 5-ALA for surgery in primary central nervous system lymphoma (PCNSL) is uncommon. Here, we present a case of PCNSL treated using 5-ALA-induced fuorescence-guided resective surgery. A 70-year-old woman presented with cerebellar ataxia, and magnetic resonance imaging revealed an irregularly shaped and homogenously enhanced mass with surrounding brain edema in the vermis that extended to the right hemisphere of the cerebellum. Under the preoperative diagnosis of a malignant glioma in the cerebellum, the patient underwent 5-ALA-induced fuorescence-guided surgery. Under blue light illumination, the tumor revealed strong 5-ALA-induced fuorescence. The tumor was identified as a difuse large B-cell lymphoma. After partial resection, the patient received adjuvant chemotherapy and radiotherapy. Importantly, the neurological deficit of the patient improved, and recurrence of the tumor was not observed 21 months post-surgery. Together with previous reports, this case study emphasizes the eficacy of the surgical application of 5-ALA for PCNSL. KEYWORDS: Glioma, Subventricular zone, Ependyma, Surgery, Difuse large B-cell lymphoma, Dissemination, 5-ALA ÖZ 5-Aminolevülinik asit (5-ALA) ile indüklenmiş foresans-eşliğinde rezeksiyon malign gliomalı hastalarda yaygın kullanılan bir tekniktir. Ancak primer santral sinir sistemi lenfoması (PSSSL) olan hastaların cerrahisinde 5-ALA kullanımı sık değildir. Burada 5-ALA ile indüklenmiş foresans eşliğinde rezektif cerrahi uygulanan bir PSSSL olgusu sunuldu. Serebellar ataksi ile başvuran 70 yaşındaki kadın hastada manyetik rezonans görüntüleme, vermisden sağ serebellar hemisfere uzanan, düzensiz sınırlı ve homojen kontrast tutan, çevre beyin dokusunda ödeme nedene olan kitle lezyonunu ortaya koydu. Preoperatif olarak serebellumda malign glioma tanısı düşünüldü ve hastaya 5-ALA ile indüklenmiş foresans eşliğinde cerrahi uygulandı. Mavi ışık aydınlatması altında tümör kuvvetli 5-ALA ile indüklenmiş foresans gösterdi. Tümörün histopatolojik inceleme sonucu difüz geniş B-hücreli lenfoma olarak geldi. Kısmi rezeksiyondan sonra hastaya ilave kemoterapi ve radyoterapi uygulandı. Önemli olarak, hastanın nörolojik defisiti düzeldi ve cerrahiden 21 ay sonra nüks gözlenmedi. Bu konudaki daha önceki raporlarla birlikte, bu olgu çalışması da 5-ALA’nın PSSSL’da cerrahi uygulamasının etkinliğini vurgulamaktadır. ANAHTAR SÖZCÜKLER: Glioma, Subventriküler bölge, Epandim, Cerrahi, Difüz geniş B-hücreli lenfoma, Yayılım, 5-ALA INTRODUCTION 5-Aminolevulinic acid (5-ALA) is a natural biochemical precursor of heme that induces the synthesis and accumulation of fuorescent porphyrins such as protoporphyrin IX (PpIX) in various cancerous tissues (17). Because 5-ALA can lead to PpIX accumulation within malignant glioma tissues, 5-ALA is primarily applied for fuorescence-guided resection of malignant gliomas by using specifcally modifed neurosurgical microscopes (10). Recently, 5-ALA has also been identifed as a promising intraoperative marker in stereotaxic biopsies for malignant gliomas (5, 15). However, clinical application of 5-ALA in primary central nervous system lymphoma (PCNSL) is currently uncommon (2, 8, 12). Here, we report a case of cerebellar PCNSL demonstrating strong 5-ALA-induced fuorescence via open resective surgery. Furthermore, we discuss the usefulness of 5-ALA in surgery for PCNSL, and review relevant literature. CASE REPORT A 70-year-old woman with diabetes mellitus experienced progressive gait disturbance and consulted our hospital. Neurological examination revealed right-sided dysmetria and an unstable wide gait. Blood sugar level on arrival and HbA1c were 169 mg/dL and 6.2%, respectively. Tests to determine serum soluble interleukin-2 receptor levels indicated no abnormalities (292.0 U/mL). Serological examination for infections and collagen disease was unremarkable. Brain