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Primary non-Hodgkin lymphoma of the brain, case 3

CLINICAL HISTORY:
This 44-year old woman complains of a several month history of pain in the neck and head, disturbances of concentration and memory. Relatives mention abnormal emotional and agressive behavior. Now she presents with a right hemiparesis and aphasia.

CLINICAL NEUROLOGICAL EXAMINATION shows a motor and sensory aphasia and a right hemiplegia, with hypoesthesia and spasticity. The level of consciousness is depressed. Difficulties with memory and mentation are noted.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGES 1 AND 2): Substantial dilatation of the lateral ventricles. Presence of diffuse hyperintensity in the left thalamus (arrow) and around the lateral ventricles (arrowheads).

b) TRANSAXIAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGES 3 AND 4): Confirmation of hydrocephalus. A lesion is seen in the left thalamus (arrow) and in the left paraventricular region (arrowheads).

c) TRANSAXIAL (IMAGES 5 - 6 - 7) AND SAGITTAL (IMAGE 8) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Presence of multiple small nodular enhancing lesions along the walls of the ventricles. The lesions are present along the fourth ventricle, the third ventricle, the temporal horn and the body of the lateral ventricle and interhemispherically. One lesion enlarges the left thalamus.

RADIOLOGICAL DIAGNOSIS is highly suggestive for lymphoma considering the periventricular location.

SURGICAL FINDINGS: Stereotactic biopsy was performed.

ANATOMOPATHOLOGY (IMAGES 9 - 10 - 11) is consistent with large cell non-Hodgkin lymphoma.
IMAGE 9 illustrates a postmortem study of another patient. The lesion appears as an ill-defined grey infiltrating lesion. A second lesion located laterally of the head of the laudate nulleus is slightly hemorrhagic. IMAGES 10 and 11 illustrate the periventricular location and the infiltration of the corpus callosum in another patient.

Treatment consisted of total cranial radiotherapy and corticosteroids.

FOLLOW-UP: Two years later the patient relapsed. Due to the poor clinical condition of the patient, no new chemotherapy was started and the patient died within 2 months.

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Primary CNS lymphoma

 

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Fig. 1

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