Medcyclopaedia Home E-learningLibraryLexical IndexLexical TopicsGlossaryFace-a-CaseSpinal CordCerebral TumorsCystic TumorsEmbryonal TumorsLocal Extension From Regional TumorsLymphomas And Hematopoetic NeoplasmsMeningeal And Mesenchymal TumorsMetastatic TumorsNeural And Mixed Neural Glial TumorsPineal Region TumorsPseudotumoral LesionsTumors Of Neuroepithelial TissueMR Neuro AngiographyTextbook of RadiologyTextbook of Radiology (e-paper)Medical Imaging Made EasyDownloadsMedcyclOasisAbout MedcyclopaediaContact Us
MedcycloPoll
Did you get the help you required from Medcyclopaedia™ during today's visit?
Yes
 
 (84.6%)
No
 
 (10.9%)
Undecided
 
 (4.5%)
You must be logged on to vote.
Please log in or register.
 
 
 

Primary non-Hodgkin lymphoma of the brain, case 1

CLINICAL HISTORY:
This 40-year old woman complains of 3 months of supraorbital and bifrontal headache. Now she presents with diplopia, disequilibrium, tinnitus and memory disturbances.

NEUROLOGICAL EXAMINATION reveals instability of gait and discrete right hemiparesis. At ophthalmological examination a Parinaud syndrome is found, with bilateral limitation of the upward and downward gaze, disturbed pupillary reflexes and third nerve paresis.

CT:
a) NON-CONTRAST SCAN (IMAGES 1 AND 2): Presence of a spontaneously hyperdense mass (arrow) in the left thalamus, with surrounding edema. The third ventricle and the foramen of Monro are shifted to the right. There is obstructive hydrocephalus. The lesion seems to extend to the mesencephalon (arrowhead image 2).

b) CONTRAST-ENHANCED SCAN (IMAGES 3 AND 4): The central part of the lesion located posteriorly in the left thalamus enhances intensely (arrowheads). The lesion appears to be very ill-defined with an irregular outline.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGES 5 AND 6): Confirmation of solid tumor nodule (arrow) within the left thalamus, with extension to the mesencephalon (arrowhead image 6). There is extensive surrounding edema extending within the white matter of the internal capsule and the optic radiation. Substantial midline shift is noted.

b) TRANSAXIAL T1-WEIGHTED (680/20/1) SPIN-ECHO SEQUENCE (IMAGES 7 AND 8): The involvement of the mesencephalon (arrow) is better appreciated. Note the compression of the colliculi (arrowheads).

c) TRANSAXIAL (IMAGES 9 AND 10) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Confirmation of irregular contrast enhancement of the lesion (arrow), extending within the mesencephalon and compressing the superior colliculi (arrowheads).

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS: is malignant tumor, such as anaplastic glioma, glioblastoma or lymphoma.

SURGICAL FINDINGS: Stereotactic biopsy of the lesion was performed.

ANATOMOPATHOLOGY showed B-cell non-Hodgkin lymphoma.

FOLLOW-UP: Therapy consisted of chemo- and radiotherapy.

CONTRAST-ENHANCED CT PERFORMED AFTER TREATMENT (IMAGES 11 AND 12): Total disappearance of the tumor.

Patient relapsed 3 years later with a new lesion in the right fronto-temporal region. Chemotherapy was restarted.

Search also:
Primary CNS lymphoma

 

The ESNR CD-Rom Series

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig. 1

Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 1
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 2
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 3
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 4
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 5
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 6
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 7
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 8
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 9
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 10
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 11
Primary non-Hodgkin lymphoma of the brain, case 1, Fig. 12