Diffuse Large B Cell Lymphoma Presented as Trigeminal Neuralgia: 2 Cases Reported and Literature Review.

Abstract

Extraaxial lymphoma involving the trigeminal nerve, an uncommon condition that presents as a trigeminal schwannoma, resulted in misdiagnosis and a flawed surgical strategy. We report 2 cases: a primary lymphoma of the Meckel cave and a metastasis lymphoma in the prepontine cistern arising from the supraclavicular lymph node. The first patient presented with a 3-month history of persistent, sharp facial pain across the area innervated by the V2 nerve. She was misdiagnosed with primary trigeminal neuralgia and underwent microvascular decompression. Intraoperatively, the trigeminal nerve was swollen to a large extent and surrounded by red granuloma-like tissue. The second case was a 75-year-old woman; she had a history of a malignant lymphoma of the supraclavicular lymph node and presented with right facial pain. Magnetic resonance imaging revealed that the cisternal portion of the right trigeminal nerve was swollen. A specimen was taken from the 2 patients, and histopathologic examinations revealed a diffuse large B cell lymphoma. The diagnosis of a malignant lymphoma should be considered for lesions in the trigeminal region. Extracting a specimen for biopsy is the most suitable surgical strategy. Our report indicates that postoperative adjuvant chemotherapy for malignant lymphomas is essential.