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Primary CNS lymphoma

Case contributed by Yaïr Glick
Diagnosis certain

Presentation

Complains of weakness and episodes of confusion.

Patient Data

Age: 75 years
Gender: Female
ct

Solid intra-axial hyperdense convoluted right frontal mass measuring approximately 3.5x4.2x4.5 cm, its epicenter in the basal ganglia. The mass enhances intensively after contrast injection. There is extensive peritumoral edema that involves the midbrain and elicits a 9-mm subfalcine herniation, effaces the frontal horn and anterior half of the right ventricle and narrows the third ventricle and displaces it leftward by 8 mm.
The hypodensity around the frontal and occipital horns of the left ventricle could signify periventricular interstitial edema secondary to a trapped ventricle.

The differential list consists mainly of CNS lymphoma and high-grade glioma.

Case Discussion

MRI brain done later on the same day was subpar due to extensive movement throughout the duration of the scan.

The mass was promptly biopsied.

Brain, right frontal region, biopsy:
The morphological and immunophenotypical features are consistent with diffuse large B-cell lymphoma of activated B-cell-like origin (ABC).
On immunostains, the lymphoma cells are positive for CD20, CD79a, BCL2, MUM1 ( more
than 50%), weakly positive for BCL6 ( 50-60%) and c-Myc( 40%) and are negative for CD10. The p53 is a weakly positive in a few scattered cells and the Ki67 proliferation antigen is positive in
70%-80% of the cells. The CD3 immunostain highlights a few scattered T-lymphocytes.

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