Primary CNS lymphoma (cerebellar)

Case contributed by Dr Derek Smith

Presentation

Transfer from DGH to neurosurgical centre. 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
Gender: Male
CT

CT in DGH

Large hyperdense and enhancing left cerebellar mass. with local edema.

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

No supratentorial masses or ischemic areas. Normal calvarium and skull base.

For MR study.

MRI

MRI in specialist center

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

CSF spaces are moderately prominent, with resolving hydrocephalus.

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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Case information

rID: 33744
Published: 22nd Jan 2015
Last edited: 29th Jan 2019
Inclusion in quiz mode: Included

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