Biomedical Journal of Indonesia Vol 7 Issue 3 2021

Biomedical Journal of Indonesia

Journal Homepage: https://www.jurnalkedokteranunsri.id/index.php/BJI/index

Malignant Brain Lymphoma Based on Age, Gender, Symptoms, Imaging

Modality, Hiv Examination, And Histopathology at Dr. Kariadi Central
General Hospital Semarang From January 2016 to December 2018
Selly Adyta Kemara 1*, Krisna Tsaniadi Prihastomo 2
1 General Surgery Resident Faculty of Medicine Universitas Diponegoro Semarang, Indonesia
2 Staff Departemen Bedah Saraf Universitas Diponegoro Semarang

A R T I C L E IN F O A B S T R A C T

Keywords: Background: Primary CNS Lymphoma (PCNSL) is rare cancer from the brain or
DLBCL spinal cord lymphatic tissue. The incidence increased in patients over 60 years, with
Non Hodgkin Lymphoma an incidence rate of 0.5/100,000 per year. PCNSL associated with poor survival. The
Brain Malignant Lymphoma aim of the study was to determine the incidence of Brain Malignant Lymphoma based
on age, gender, symptoms, imaging modalities, HIV examination, and
histopathological results at dr. Kariadi Semarang.
Correspondi ng author: Methods: This is a retrospective descriptive study. We collected bra in malignant
Selly Adyta Kemara lymphoma patient’s medical records who came to the ER and the Neurosurgery
Polyclinic of Dr. Kariadi Semarang from period January 2016-December 2018.
Results: There were 1,012 brain tumor patients, 6 patients were brain malignant
E-mail address: lymphoma with the highest prevalence in the age range of 45-65 years (5 patients)
selly.adyta@gmail.com and 66.67% male. The most common symptom was blurred vision 23.07%. The
imaging modalities showed lesions on: right parietal lobe 14.29%, sella region
14.29%, parasella region 14.29%, cerebellum 14.29%, IV ventricle 14.29%, vertebrae
sacrum 2-5 14.29 %, and the fronto-temporo-parietal region 14.29%. No HIV test
All authors have reviewed and
data were obtained. According to histopathology, Diffuse large B cell Lymphoma
approved the final version of the
manuscript. Malignant non Germinal Center (DLBCL) and High grade, B cell Non Hodgkin
Lymphoma (small type) each were 33.33%.
Conclusions: The prevalence of malignant brain lymphoma cases was highest in the
https://doi.org/10.32539/BJI.v7i3.540 45–65 year age group and male, with blurred vision. Most of the results of imaging
modalities show an even distribution of brain malignant lymphomas and generally
do not do HIV testing. The most common histopathological diagnosis was DLBCL.

1. Introduction
Primary cerebral lymphoma is a rare cancer that extranodal lymphomas.1 However, in recent years,
begins in the lymph tissue of the brain or spinal cord. an increased incidence has been recognized,
Primary cerebral lymphoma is also known as brain especially in patients older than 60 years, with The
lymphoma or central nervous system lymphoma. incidence rate is 0.5 per 100,000 per year.
Primary CNS Lymphoma (PCNSL) is a highly Approximately 1,500 new patients are diagnosed
aggressive non-Hodgkin's lymphoma confined to the each year in the United States. 2
CNS, including the brain, spine, cerebrospinal fluid Patients with PCNSL develop neurologic signs over
(CSF), and eyes. PCNSL may develop in patients with several weeks, including focal neurological deficits
immunosuppressive conditions (HIV/AIDS, organ (56% to 70%), altered mental status and behavioral
transplantation, immunosuppressive agents) or in changes (32% to 43%), symptoms of increased
immunocompetent patients. PCNSL in intracranial pressure (headache, nausea, vomiting,
immunocompetent patients is rare and represents papilledema, 32% to 33%), and seizures (11% to
4% of all intracranial neoplasms and 4% to 6% of all
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14%), depending on the site of involvement in the medical records and digital data. Data collection was
CNS.3 carried out by a researcher. The collected data is

PCNSL has historically been associated with poor checked for completeness and correctness of the data

survival. However recent studies provide some (data cleaning). The data was processed using
support that survival has improved, perhaps Microsoft Excel 2016 software for Windows and

reflecting an intensification of treatment and new presented in graphical form.

treatment options other than radiotherapy.
Independent predictors among these patients were 3. Results
gender, HIV status, race and age at diagnosis. 4 This study was carried out retrospectively
descriptively from medical records in patients with
2. Methods brain tumors and brain malignant lymphoma at
This research is a descriptive study with RSUP dr. Kariadi Semarang in the period January

retrospective analysis. The study was conducted by 2016-December 2018 and obtained 1,012 cases. Of

collecting data based on observations of the medical the 1,012 cases, data on age, sex, symptoms, imaging

records of brain malignant lymphoma patients who modalities, HIV examination, tumor type and

came to the ER or Neurosurgery clinic at Dr. Kariadi histopathological results were obtained. There were
Hospital Semarang during January 2016 to some patients who could not be used as research

December 2018. Patient data was collected by samples due to incomplete data, no surgery or no

processing data from the medical record section of dr. histopathological results. After exclusion, 6 complete

Kariadi Hospital manually from written records in respondent data were obtained.

Age
6

0
0-16 17-25 26-45 45-65

Figure 1. Age of Malignant Brain Lymphoma Patients

The graph above is a description of respondents prevalence at the age of 45-65 years as many as 5
with malignant brain lymphoma based on age, it is people and age 26-45 years as many as 1 person.
known that there are 6 respondents with the highest

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 Gender

Female
Male

Figure 2. Gender of Malignant Brain Lymphoma Patients

Among the 6 respondents, it is known that the by 4 people (66.67%), while female respondents are 2
largest number of respondents are male respondents people (33.33%).

Symptoms

9%
9% 28%

18%
18%

18%

Blurred Vision Headache Balance disorder Speech Impairment Weak Limbs Dizziness

Figure 3. Symptoms of Malignant Brain Lymphoma Patients

Based on the diagram above, the sample symptom impairment (2 samples; 15.38%), weak limbs (1
variations in this study are: blurred vision (3 sample; 7.69%), spinning dizziness (1 sample;
samples; 23.07%), headache (2 samples; 15.38%), 7.69%), low back pain (1 sample; 7.69%), and lumps
balance disorders (2 samples; 15.38%), speech on the right temporal (1 sample; 7.69%).

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 Imaging Modality
2

Figure 4. Imaging Modality Results of of Malignant Brain Lymphoma Patients

The graph above is a description of respondents sella (1 sample; 14 samples). .29%), parasella region
with brain malignant lymphoma based on the results (1 sample; 14.29%), cerebellum (1 sample; 14.29%),
of imaging modalities, it is known that each IV ventricle (1 sample; 14.29%), 2-5 sacral vertebrae
respondent has different imaging modalities, namely (1 sample; 14 .29%), and the fronto-temporo-parietal
in the right parietal lobe (1 sample; 14.29%), region region (1 sample; 14.29%).

HIV testing

17%

83%

Not tested HIV (-)

Figure 5. HIV testing on Malignant Brain Lymphoma

Based on the diagram above, of the 6 respondents 5 (83.33%) were not tested for HIV, and 1 respondent
who were diagnosed with brain malignant lymphoma, (16.67%) was tested for HIV with an HIV result (-).

Tabel 1. Tipe Limfoma Maligna Otak berdasarkan hasil histopatologis

Histopathologic Examination Frequency Percentage
Diffuse large B cell Lymphoma Maligna non Germinal 2 33,33 %
Centre
Lymphoplasma cytic lymphoma 1 16.67 %
High grade, B cell Non Hodgkin Lymphoma (small type) 2 33,33 %
Diffuse Small Type B cell Non Hodgkin Lymphoma 1 16,67 %

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 The table above shows the most common types of which is 2 patients (33.33%), and High grade, B cell
Brain Malignant Lymphoma based on Non Hodgkin Lymphoma (small type), which is 2
histopathological examination, namely Diffuse large patients. (33.33%).
B cell Lymphoma Malignant non Germinal Center,

Malignant Brain Lymphoma Type

2,5

1,5

0,5

0
A B C D

Figure 6. Types of Malignant Brain Lymphoma

Informations :
A : Diffuse large B cell Lymphoma Maligna non Germinal Centre
B : Lymphoplasma cytic lymphoma
C : High grade, B cell Non Hodgkin Lymphoma (small type)
D : Diffuse Small Type B cell Non Hodgkin Lymphoma

4. Discussion especially in people aged sixty-five years and over,

This study was conducted on 1,012 subjects with where the median age at diagnosis is 56 years. 5
brain tumors, of which 6 were patients with Brain Based on the gender group, it can be described
Malignant Lymphoma, who had been treated and from 6 patients with Brain Malignant Lymphoma, it
underwent surgery at dr. Kariadi Hospital Semarang is known that the largest number of male
in January 2016-December 2018 and met the respondents is 4 people (66.67%), while female
research criteria. This study aims to compare the respondents are 2 (33.33%). Another study by Villano
incidence of Brain Malignant Lymphoma and Brain et al stated that the ratio of patients with Brain
Tumor based on age, sex and histopathological Malignant Lymphoma prevalence in males was higher
results at dr. Kariadi Hospital Semarang in the than females with a ratio of 1.2:1 – 1.7:1.1
period between January 2017-December 2018. Based on the symptoms experienced, which can
Among 1,012 patients with Brain Tumors, 6 be described from 6 patients with Brain Malignant
patients suffered from Brain Malignant Lymphoma, Lymphoma, the highest prevalence of symptoms was
where the highest number of patients was in the age blurred vision, experienced by 3 patients (23.07%).
range of 45-65 years as many as 5 patients (0.99%) This is in accordance with the theory which states
of the total 501 Brain Tumor patients in this age that the presentation of intraocular symptoms is seen
group. This is consistent with the theory that the in 5-20% of PCNSL cases. Intraocular symptoms
overall incidence of these neoplasms increases, precede brain lesions in 95% of patients; both eyes
are involved in 80% of cases. Diagnosis can be

485
difficult; Patients generally complain of floaters and January 2016-December 2018 as many as 2 patients
blurred vision, which is caused by uveitis. 6,7 or 33.33%. These results are in accordance with
Based on the results of imaging modalities, research from the Working Formulation which states
obtained from 6 respondents with malignant brain that the most commonly identified types of Brain
lymphoma, the results were varied and evenly Malignant Lymphoma are Diffuse large B cell
distributed, namely: right parietal lobe (1 sample; Lymphoma Malignant non Germinal Center and High
14.29%), sella region (1 sample; 14.29%), parasella grade (DLBCL) 1,11
region ( 1 sample; 14.29%), cerebellum (1 sample;
14.29%), IV ventricle (1 sample; 14.29%), 2-5 sacral 5. Conclusion
vertebrae (1 sample; 14.29%), and fronto region - The prevalence of brain malignant lymphoma
temporo-parietal (1 sample; 14.29%). This is in cases at dr. Kariadi Hospital Semarang in the
accordance with other research that there are January 2016 – December 2018 period was mostly at
variations in the results of imaging modalities 8 the age of 45 – 65 years, male sex, with symptoms of
In immunocompetent PCNSL patients, lesions are blurred vision, imaging modalities showed an even
solitary in 65% of cases and located in the cerebral distribution and HIV testing was not carried out.
hemispheres (38%), thalamus or basal ganglia (16%), Based on the results of histopathological
corpus callosum (14%), periventricular regions (12%), examination, the most common types of Brain
and cerebellum (9%) ). HIV-associated PCNSL were Malignant Lymphoma are Diffuse large B cell
solitary lesions in 48.6% of cases and localized to the Lymphoma Malignant non Germinal Center and High
cerebral cortex in 65%, periventricular region in 56%, grade (DLBCL).
basal ganglia in 33%, cerebellum in 7%, and brain in
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