CNS lymphoma

Case contributed by RMH Neuropathology

Presentation

Decrease in mental state. No primary known malignancy.

Patient Data

Age: 79
Gender: Male

CT Brain

Modality: CT

CT brain shows two hyperdense nodular deep white matter lesions located in the right corona radiata region and in the left frontoparietal transition, both associated with an extensive hypoattenuating area surrounding them and that may correspond to a vasogenic oedema. The mass effect is more pronounced in the right where it causes a mild right lateral ventricle compression; bilateral mild sulcal effacement. No midline shift. It is also notated a small not well-defined hypoattenuating area in the left cerebral peduncle. 

 

MRI Brain

Modality: MRI

MRI brain demonstrating again the right frontal lobe and left frontoparietal white matter nodular lesions associated with a extensive vasogenic oedema. Both lesions show homogeneous and intense contrast enhancement and the left one a mild haemorrhagic posterior component. The study also evidences a similar enhanced nodular lesion in the left cerebral peduncle. 

Modality: Pathology

MICROSCOPIC DESCRIPTION: 1&2: Paraffin sections show fragments of brain parenchyma which are densely infiltrated by a population of atypical large lymphoid cells mixed with smaller mature lymphocytes. The large cells have convoluted vesicular nuclei, many with conspicuous nucleoli and a varying amount of pale cytoplasm. Both populations are arranged in diffuse sheets as well as cuffs around blood vessels. The walls of some vessels are obliterated by the infiltrate. Immunohistochemistry shows positive staining in tumour cells for CD20 and CD5. Scattered atypical cells show positive staining for MUM-1. Atypical cells are negative for CD3, CD10, CD23, cyclin D1, CD30, bcl-2, bcl-6 and EBV-LMP. Moderate numbers of small mature CD3+ T lymphocytes are mixed with the large atypical B cells. The features are of non-Hodgkin's large B cell lymphoma. DIAGNOSIS: "Right frontal brain lesion": non-Hodgkin's diffuse large B cell lymphoma.

Case Discussion

Primary CNS lymphoma accounts for approximately 1% of all extranodal lymphoma, and ~1% of intracranial tumours.

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Case Information

rID: 36983
Case created: 21st May 2015
Last edited: 12th Dec 2016
Tag: rmh
Inclusion in quiz mode: Included

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