Primary CNS lymphoma (cerebellar)

Case contributed by Derek Smith

Presentation

Transfer from DGH to neurosurgical center. Presented with few weeks of headache and reduced appetite. Worsening positional headache and new vomiting and dizziness. On examination, moderate cerebellar dysfunction (ataxia, poor alternating movements, dysdiadochokinesis).

Patient Data

Age: 65 years
Gender: Male

CT in DGH

ct

Large hyperdense and enhancing left cerebellar mass. with local edema. Left cerebellar encephalocele into the occipital inner table.

Obstructive hydrocephalus with ventricular enlargement and periventricular low density (compatible with CSF shift).

No supratentorial masses or acute ischemic areas. Right frontal encephalomalacia (presumed prior infarct). Normal calvarium and skull base.

For MR study.

MRI in specialist center

mri

Homogeneously enhancing, 35 mm, solitary, left cerebellar infiltrative mass with mild mass effect and diffusion restriction.  Right frontal encephalomalacia. Parenchyma otherwise returns normal signal.

CSF spaces remain prominent, with resolving hydrocephalus. Left occipital bone encephalocele.

Case Discussion

The patient received steroids prior to transfer to the neurosurgical center.

He underwent decompressive resection of the tumor. The post-operative recovery was uneventful.

Pathology returned diffuse large B-cell lymphoma. There was no evidence of other malignancy on investigation and HIV serology was negative.

Chemoradiotherapy was delivered and follow up cerebral MR at three months showed no evidence of recurrence.

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