Non-enhancing relapse of a primary CNS lymphoma with multiple diffusion-restricted lesions

J Neurooncol. 2011 Mar;102(1):163-6. doi: 10.1007/s11060-010-0287-5. Epub 2010 Jul 3.

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.

Publication types

  • Case Reports

MeSH terms

  • Brain Neoplasms / complications
  • Brain Neoplasms / pathology*
  • Brain Neoplasms / therapy
  • Combined Modality Therapy
  • Diffusion Magnetic Resonance Imaging*
  • Eye Neoplasms / complications
  • Eye Neoplasms / pathology*
  • Eye Neoplasms / therapy
  • Fatal Outcome
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / complications
  • Lymphoma, Large B-Cell, Diffuse / pathology*
  • Lymphoma, Large B-Cell, Diffuse / therapy
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / complications
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm Recurrence, Local / therapy