Primary CNS lymphoma with recurrence


  • A 45 years old male
  • Presented with right upper limb weakness and headache.
  • CT brain showed left fronto-parietal lesion with midline shift.
MRI brain in axial planes; (A-C) T1WI, (D-E) T2FLAIR and (G-I) T1+Gadolinium
MRI brain axial plane post contrast
MRI brain; T2WI for upper row and T1+Gadolinium for lower row

MRI findings:

  • There is a lesion at the left frontal region with marked surrounding vasogenic oedema (yellow arrows).
  • It enhances post contrast, with evidence of central necrosis .
  • There is mass effect onto the body of the ipsilateral lateral ventricle with slight midline shift to the contralateral side.
  • Similar enhancing lesions with significant vasogenic oedema are seen in the left posterior parietal lobe and also splenium of the corpus callosum (white arrows).
  • No evidence of hydrocephalus.
  • There is effacement of the left cerebral sulci.

Progress of patient:

  • Based on MRI findings, with presence of central necrosis GBM was given as diagnosis.
  • Left frontotemporal craniotomy and tumour excision was done.
  • HPE came back as B-cell lymphoma
  • CT scan of neck, thorax, abdomen and pelvis show no significant finding.
  • Patient was started on chemotherapy and shows good respond.
  • After 4 years remission, patient presented again with short term memory loss and abnormal behaviour
  • Repeat MRI shows more typical appearance of CNS lymphomas with multifocal periventricular lesion suggestive of recurrence.
MRI brain after completed chemotherapy; (A-D) T1WI, (E-H) T2WI and (I-L) T1+gadolinium


MRI brain axial plane T1+ Gadolinium, comparison in 2008 and 2012

Final diagnosis: Primary CNS lymphoma with recurrence


  • Primary CNS lymphoma are previously rare, currently relatively more commonly seen,  ranks behind meningioma and low grade gliomas.
  • It accounts for 2.5% of all brain tumours.
  • Typically patients are over the age of 50 with a short duration of symptoms.
  • There is a male predominance of approximately 2:1
  • Classic imaging appearance for primary CNS lymphoma is of a CT hyperdense avidly enhancing mass, with T1 hypointense, T2 iso- to hypointense, vivid homogeneous gadolinium-enhancing lesion(s) with restricted diffusion on MRI, and exhibiting subependymal extension and crossing of the corpus callosum.
Author: radhianahassan