Lymphomatosis cerebri

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

Previous history of HCC and HCV infection.

Patient Data

Age: 70 years
Gender: Male

CT Brain

ct

Ill-defined hypoattenuation within the left temporal lobe, insular lobe and basal ganglia white matter, as well as involving the splenium of the corpus callosum, non-specific, without evident mass effect or contrast enhancement. MRI should be considered for a better assessment. 

MRI Brain

mri

Diffuse and ill-defined areas of high T2/FLAIR signal involving the white matter along the left frontotemporal and insular lobes, splenium of the corpus callosum, basal ganglia on the left, and extending inferiorly through the thalamus to the left cerebellar peduncle and mesencephalon. Foci of restricted diffusion are present in those areas and enhancement is irregular and scattered throughout the lesion. 

pathology

MICROSCOPIC DESCRIPTION: 1-4. Paraffin sections show fragments of brain parenchyma. All of these show varying degrees of infiltration by atypical large mononuclear cells distributed predominantly as single cells between fiber tracts. Large solid aggregates of atypical cells are seen in specimen 4. Infiltration through the walls of several small caliber blood vessels is also seen in specimen 4. There is florid reactive astrocytic gliosis in all specimens. No evidence of demyelination is seen.

Immunohistocheistry shows the atypical large cells to be CD20+, bcl-2+, bcl-6+, MUM1+, CD3-, CD10-, GFAP-, cytokeratin CAM5.2-, CD68-, EBV-. The features are of lymphomatosis cerebri (non Hodgkin's large B cell - non germinal center phenotype)

DIAGNOSIS: 1-4: Brain biopsies: Lymphomatosis cerebri (non Hodgkin's large B cell - non germinal center phenotype)

SUPPLEMENTARY REPORT: About 20% of the tumor cells are c-myc immunostain positive. About 25% of the cells are p53 positive.

Case Discussion

This case illustrates a rare form of primary central nervous system lymphoma (PCNSL)

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.