CNS lymphoma

Case contributed by Frank Gaillard
Diagnosis certain

Patient Data

Age: 60 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

MRI head

mri
This study is a stack
Axial
T2
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Axial
FLAIR
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Axial
T1
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Axial
T1 C+
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Axial
DWI
This study is a stack
Axial
ADC
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Coronal
T2
This study is a stack
Coronal
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Sagittal
T1
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Info

Multiple periventricular regions of vivid contrast enhancement, which are low on T2 and surrounded by relatively little edema. They also demonstrate restricted diffusion in keeping with a highly cellular tumor. Features are characteristic of CNS lymphoma. 

Histology

pathology
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MICROSCOPIC DESCRIPTION:

The sections show a densely cellular malignant tumor in the white matter. It forms diffuse sheets and cuffs around the blood vessels. The tumor cells are intermediate in size. They have enlarged clefted and hyperchromatic nuclei, prominent nucleoli and scanty cytoplasm. The tumor cells are CD20, PAX-5, bcl-2, bcl-6 and MUM1 positive. The Ki-67 index is about 80%. They are CD3 and CD10 negative. There is insufficient tissue for EBER-CISH. The features are those of diffuse large B-cell lymphoma with activated B-cell-like phenotype.

DIAGNOSIS:

Diffuse large B-cell lymphoma.

Case Discussion

This is a typical radiological appearance of CNS lymphoma, and the diagnosis can be suggested with a high degree of certainty. 

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