Non-enhancing relapse of a primary CNS lymphoma with multiple diffusion-restricted lesions.
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.
Fischer
Lars
L
Department of Hematology and Oncology, Charité Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. lars.fischer@charite.de
Koch
Arend
A
Schlegel
Uwe
U
Koch
Hans-Christian
HC
Wenzel
Rüdiger
R
Schröder
Nicolas
N
Thiel
Eckhard
E
Korfel
Agnieszka
A
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