Primary CNS lymphoma

Case contributed by Bita Abbasi
Diagnosis almost certain

Presentation

Headache with history of renal transplant

Patient Data

Age: 35 years
Gender: Female
ct

 Hyperdense CT mass in a deep supratentorial location. There is extensive adjacent edema. On these images it is difficult to definitely distinguish an extra-axial lesion arising from the sphenoid wing, from an intraparenchymal lesions (the latter is favored). 

mri

Solitary lesion is isointense on FLAIR and slightly hypointense on T1 images. Prominent restricted diffusion. Avid homogeneous enhancement is noted in post contrast images.

Case Discussion

The biopsy result was non Hodgkin's lymphoma.

The incidence of CNS lymphoma has increased in recent years due to the increased number of immunocompromised patients (organ transplant, HIV infection, etc.). In this clinical context, it represents primary CNS post-transplant lymphoproliferative disorder. In this case, the appearances are those seen in sporadic primary CNS lymphoma, without the features often present in immunocompromised patients (e.g. multiple lesions, central non-enhancement). 

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