Primary central nervous system diffuse large B-cell lymphoma in fourth ventricle: Case report and literature review

Rationale: Primary central nervous system lymphoma (PCNSL) is rare, especially lymphoma arising in the fourth ventricle. Only a few cases have been reported. We report a case of fourth ventricular lymphoma and review the relevant literature. Characterizing these cases can provide a basis for optimizing the diagnosis and management of fourth ventricle lymphoma. Patient concerns: A 48-year-old male with blurred vision, dizziness, staggering persisting for 2 months was admitted. Diagnosis: Preoperative magnetic resonance imaging revealed a space occupying lesion of the fourth ventricle. The patient presented with symptoms of hydrocephalus before surgery, such as memory loss and slurred speech. Pathological analysis following complete resection confirmed the lesion as PCNSL. Intervention: The patient underwent a midline posterior fossa craniotomy. Outcomes: The patient symptoms were relieved after surgery. Postoperative chemotherapy was administered with our regular follow-up. Follow-up 9 months after operation indicated a good prognosis. Lessons: According to the literature, biopsy surgery and subsequent chemotherapy are generally considered as the best treatment options for PCNSL. We believe that for the special location of the fourth ventricle, lymphomas in this site are suitable for the combination of complete resection and subsequent chemotherapy. This approach facilitates tumor resection and reduces possibility of obstructive hydrocephalus.