Primary central nervous system lymphoma with cortical laminar hemorrhage.
Here we report a case of primary central nervous system (CNS) lymphoma with cortical laminar hemorrhage. The present case showed an acute onset of focal neurologic signs and bilateral cortical lesions surrounded by peripheral white matter edema on magnetic resonance imaging. A part of the left frontal cortical lesion was hyperintense on T1-weighted images and hypointense on T2-weighted and T2-weighted gradient-echo images, suggesting subacute laminar hemorrhage. The patient was initially diagnosed with multiple hemorrhagic infarctions, but a biopsy specimen revealed diffuse large B-cell lymphoma with hemosiderin deposits. Immunohistochemical studies revealed that the tumor cell cytoplasm and membrane stained positively for anti-vascular endothelial growth factor antibody. The present case reconfirms the danger of making a specific lymphoma diagnosis based on magnetic resonance imaging findings alone and that histopathologic examination following brain biopsy is necessary for a correct diagnosis. Vascular endothelial growth factor expression might be associated with the intratumoral hemorrhage.
Kimura
Noriyuki
N
Department of Internal Medicine III, Faculty of Medicine, Oita University, Oita, Japan. noriyuki@med.oita-u.ac.jp
Ishibashi
Masato
M
Masuda
Teruaki
T
Morishige
Masaki
M
Abe
Tatsuya
T
Fujiki
Minoru
M
Kashima
Kenji
K
Kumamoto
Toshihide
T
D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism; D001706:Biopsy; D001929:Brain Edema / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008223:Lymphoma / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009044:Motor Cortex / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D009389:Neovascularization, Pathologic / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D010291:Paresis / Q000209:etiology; D010296:Parietal Lobe / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D013003:Somatosensory Cortex / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis / Q000378:metabolism
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D042461:Vascular Endothelial Growth Factor A