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Case report describes treatment response in rare dual-lesion DLBCL with heterogeneous subtypesDoctors describe treatment response in rare case of dual-lesion lymphoma

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Key Takeaway
Consider this single case report as a reference for rare, heterogeneous DLBCL, but recognize its limited generalizability.

A case report and systematic review describes a 65-year-old female patient with a rare presentation of diffuse large B-cell lymphoma (DLBCL) featuring dual intracranial and extracranial lesions with heterogeneous molecular subtypes (intracranial ABC type and temporal muscle GCB type). The initial treatment consisted of 2 cycles of rituximab combined with high-dose methotrexate chemotherapy, which resulted in stable disease (SD) for the intracranial lesion and a complete response (CR) for the temporal muscle lesion. Subsequently, the patient received 6 cycles of cytarabine combined with temozolomide chemotherapy followed by radiotherapy for the intracranial lesion, achieving a partial response (PR) in the intracranial lesion and a sustained CR in the muscle lesion. At the time of follow-up, the patient's condition was reported as stable without recurrence. Safety and tolerability data were not reported. The primary limitation is that this is a single case report; the number of studies included in the accompanying literature review was not reported, and there is no control group, statistical analysis, or comparative data. The authors suggest the findings provide a clinical reference for the diagnosis and individualized treatment of such rare cases, but the evidence is insufficient to guide general practice due to the lack of generalizable data.

Doctors described the treatment of a 65-year-old woman with a very rare form of cancer called diffuse large B-cell lymphoma. In her case, the cancer appeared in two separate places—inside her skull and in a muscle near her temple—and tests showed these two tumors were actually different subtypes of the disease. This made her treatment more complex.

Her doctors first tried two cycles of a chemotherapy combination. The muscle tumor disappeared completely, but the brain tumor remained stable. They then switched to a different chemotherapy regimen for six cycles and added radiotherapy specifically for the brain tumor. After this adjusted treatment, the brain tumor showed partial shrinkage, and the muscle tumor remained gone. At her last follow-up, her condition was stable with no signs of the cancer returning.

It is crucial to understand that this is a detailed report of just one patient's experience. The report does not mention any specific side effects from the treatments. Because every cancer case is unique, especially such rare ones, what worked for this patient may not work for others. This report serves mainly as a reference for doctors who might encounter a similar, highly unusual case in the future, highlighting the need for personalized treatment plans.

What this means for you:
A single case of rare, dual-lesion lymphoma showed different responses to treatment. This finding is not generalizable.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of malignant lymphoma in adults. According to the gene expression profile, it can be classified into germinal center B-cell (GCB) type and activated B-cell (ABC) type. Cases with coexistence of the two subtypes and cross-site involvement are extremely rare. Herein, we report a 65-year-old female patient who presented with blurred vision in the right eye. Imaging examinations revealed space-occupying lesions in the left thalamus, basal ganglia, deep temporal lobe and left temporal muscle. Pathological biopsy and immunohistochemistry confirmed that the intracranial lesion was ABC subtype DLBCL and the temporal muscle lesion was GCB subtype DLBCL. Fluorescence in situ hybridization (FISH) excluded c-MYC, Bcl-2 and Bcl-6 gene rearrangements. No involvement of other sites was detected by PET-CT and bone marrow biopsy. The patient initially received 2 cycles of rituximab combined with high-dose methotrexate chemotherapy. Efficacy evaluation showed stable disease (SD) of the intracranial lesion and complete response (CR) of the temporal muscle lesion. Subsequently, the regimen was adjusted to 6 cycles of cytarabine combined with temozolomide chemotherapy followed by radiotherapy for the intracranial lesion. Eventually, the intracranial lesion achieved partial response (PR) and the temporal muscle lesion maintained sustained CR. Up to the date of follow-up, the patient’s condition was stable without recurrence. Combined with literature review, this article discusses the possible mechanisms of the coexistence of dual-subtype DLBCL (clonal evolution or biclonal origin), the potential pathways of temporal muscle metastasis and the impact of subtype differences on treatment response, which provides clinical reference for the diagnosis and individualized treatment of such rare cases.
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