Presentation
Patient with recurrent headaches with a known history of primary CNS B-cell lymphoma.
Patient Data
Signs of a right frontal craniotomy with a right frontal lobe resection cavity communicating with the anterior horn of the lateral ventricle. Extensive vasogenic edema in frontal lobes and left parietal lobe. FLAIR images demonstrate a hyperintense lesion extending from resected part of body corpus callosum to the left cingulate gyrus, best seen on axial planes; hyperintense signal from dura mater above right frontal lobe. Axial DWI demonstrates restricted diffusion of this lesion with corresponding ADC maps. Postcontrast T1 fat-suppressed images demonstrate vivid heterogeneous enhancement.
Case Discussion
This patient has a pathologically proven primary CNS B-cell lymphoma. Unfortunately, there is no information about his HIV status, but he received immunosuppression therapy. There are clear signs of tumor recurrence from resected part of body corpus callosum and further involvement of the left cingulate gyrus. Mild dural enhancement and hyperintensity on FLAIR images at right frontal region may be postsurgical or residual involvement of dura mater. MRI findings are in keeping with lymphoma: typical diffusion restriction, vivid but no homogenous enhancement most likely due to patient's immunosuppression.
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