Primary CNS lymphoma

   April 18, 2021  Posted in Central Nervous System, Tumour

Case contribution: Dr Radhiana Hassan

Clinical:

  • A 61 years old lady
  • Presented with chronic headache for 4 years
  • Associated with giddiness and blurred vision
  • On and off fever, no body weakness
Contrast enhanced CT brain in axial plane soft tissue windows
CT scan brain; (upper row) plain and (lower row) post contrast in brain window
CT scan brain in coronal reformatted image; (G-H) plain and (I-J) post contrast.

CT scan findings:

  • Hyperdense lesions are seen at white matter of right parietal and right cerebellum
  • The lesions are located at periventricular region
  • It shows marked enhancement post contrast
  • Areas of central non-enhancing hypodensity is seen
  • Significant perilesional oedema is seen
  • No midline shift or hydrocephalus

Diagnosis: Primary CNS lymphoma (HPE proven)

Progress of patient:

  • CT scan thorax, abdominal pelvis are normal
  • Burrhole biopsy done, HPE revealed DLBCL
  • Completed chemotherapy, shows good response
  • Planned for radiotherapy

Discussion:

  • Primary CNS lymphoma is an uncommon brain tumours.
  • On imaging, characteristically is is seen as hyperdense enhancing supratentorial lesion as in this case.
  • However, usually the enhancement is intense with no area of necrosis.
  • There is little associated vasogenic oedema.
  • Mainly the lesions are solitary (60-70%); multiple lesion seen in 30-40%
  • There is predilection for periventricular white matter.
  • But it can also occur in cortex or deep gray matter
  • It is most frequently found in supratentorial brain (70%)

 

Author: radhianahassan