Primary CNS lymphoma

Case contributed by Keshaw Kumar
Diagnosis certain

Presentation

Headache and vomiting

Patient Data

Age: 75 years
Gender: Female

CEMRI Brain

mri
This study is a stack
Axial
T1
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Axial
T2
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Sagittal
T2
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Axial
DWI
This study is a stack
Axial
ADC
This study is a stack
Axial
FLAIR
This study is a stack
Axial
T1 C+
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Info

There is a small, well-defined lobulated mass lesion in the right superior frontal lobe in the subcortical region with marked surrounding vasogenic edema. The lesion appears isointense to grey matter on T1W / T2W/FLAIR images and shows diffusion restriction on DWI. Vivid homogenous enhancement is seen on post-contrast images. Another tiny nodular enhancing lesion is seen just posterosuperior to the above lesion.

Post biopsy CT brain

ct
This study is a stack
Axial
non-contrast
This study is a stack
Axial bone
window
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Post-biopsy CT brain shows the lesion is slightly hyperdense with moderate surrounding edema.

Craniotomy defect in the right frontal bone.

Hyperostosis frontalis interna seen ( Insignificant finding).

Notch sign

Annotated image
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Notch sign refers to irregular growth pattern as well as pliable and infiltrative properties of the tumor.

Case Discussion

The immunohistopathological report of the lesion shows diffuse large B-cell lymphoma (DLBCL). There is no co-existing systemic disease and the patient was immunocompetent.

Co-author: Dr. Deepa N A. DM (Neuro medicine).

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