title: Non-enhancing relapse of a primary CNS lymphoma with multiple diffusion-restricted lesions.
abstract: Primary CNS lymphoma (PCNSL) and its variant primary intraocular lymphoma (PIOL) are rare forms of extranodal non-Hodgkin's lymphoma confined to the CNS including the retina and the optical nerve; histologically, most cases are diffuse large B cell lymphomas. PCNSL in immunocompetent patients display typical radiological features on MRI, i.e. intensely and homogeneously enhancing lesions with moderate edema. Here, we report a 52-year-old male with a history of a PIOL and two consecutive intracerebral relapses who presented with dysarthria, dysphagia, and gait ataxia. Gadolinium-enhanced T1 scans were unremarkable but multiple lesions with restricted water diffusivity were seen on diffusion-weighted imaging. Relapse of his PCNSL was secured histologically only on autopsy. The possible etiology of the diffusion-restricted lesions is discussed.
authors.affiliation: Department of Hematology and Oncology, Charité Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. lars.fischer@charite.de
authors.forename: Lars
authors.initials: L
authors.lastname: Fischer
authors.forename: Arend
authors.initials: A
authors.lastname: Koch
authors.forename: Uwe
authors.initials: U
authors.lastname: Schlegel
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Koch
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Wenzel
authors.forename: Nicolas
authors.initials: N
authors.lastname: Schröder
authors.forename: Eckhard
authors.initials: E
authors.lastname: Thiel
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Korfel
mesh_terms: D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D038524:Diffusion Magnetic Resonance Imaging; D005134:Eye Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000473:pathology* / Q000628:therapy