Primary CNS lymphoma (PCNSL)

Case contributed by Bruno Di Muzio
Diagnosis almost certain

Presentation

Seizure.

Patient Data

Age: 85 years
Gender: Female

Brain

ct
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Info

Enhancing intra-axial lesion crossing the splenium of the corpus callosum and additional enhancing mass centered in the fourth ventricle. Suggestion of rim of enhancement adjacent to the frontal horn right lateral ventricle.

Brain

mri
This study is a stack
Axial
T2
This study is a stack
Axial
FLAIR
This study is a stack
Axial
CISS
This study is a stack
Axial
T1
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
This study is a stack
Coronal
Gradient Echo
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
This study is a stack
Sagittal
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Info

MRI shows vividly enhancing mass involving the splenium of the corpus callosum and subependymal extension within the anterior horns of the lateral ventricles and at the floor of the fourth ventricle. The corpus callosum prominent mass has diffusion restriction inferring high cellularity and surrounding vasogenic edema. 

Case Discussion

Although not histologically proven, this case brings typical imaging features of CNS lymphoma characterized by a high-cellular periventricular mass with low ADC values and vivid and homogeneous contrast enhancement. Other differentials are felt unlikely. 

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