Primary CNS lymphoma
Loss of weight and confusion.
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Findings: There is an avidly enhancing, mildly irregular mass centered on the genu of the corpus callosum in the frontal lobes, crossing the midline involving both the left and right frontal lobes with extensive surrounding vasogenic edema. A further similar mass is seen just inferiorly within the inferior left frontal lobe which also demonstrates surrounding vasogenic edema.
There is significant mass-effect with compression of the frontal horns of both lateral ventricles and approximately 5 mm of midline shift to the right at the level of the body of the lateral ventricles. No hydrocephalus. No hemorrhage.
A further, partly calcified, enhancing extra-axial mass is seen deep to the inner table of the right pterion. This does not demonstrate significant surrounding edema and has features highly suggestive of a meningioma.
No evidence of acute parenchymal infarction. Subtle periventricular low attenuation is in keeping with chronic deep white matter ischemic change.
No extra-axial hemorrhage.
Conclusion: Enhancing frontal mass lesions centered on the genu of the corpus callosum and inferior left frontal lobe, as described above. The appearances favor an high-grade butterfly glioma or lymphoma, although, given the clinical history, metastatic disease is also a possibility but felt less likely.
A further right extra-axial lesion over the pterion has features in keeping with a meningioma.
The findings have been discussed with the referring physician.
Biopsy proven CNS lymphoma. Features of this CNS neoplasm are:
- the great majority are diffuse large B-cell, non-Hodgkin lymphomas
- usually supratentorial
- usually hyperdense on CT and showing restricted diffusion on DWI/ADC (high cellularity)
- periventricular and subependymal locations are typical
The involvement of the corpus callosum in this way has a few differentials to be considered: PCNSL, glioblastoma, and metastasis.
Also in this case, a further right extra-axial lesion over the pterion has featured in keeping with a meningioma.