Primary CNS lymphoma

Discussion:

The first images in this case, although atypical, raised the possibility of the lesion be related to an aneurysm, especially for being hyperdense and with a bright enhancement. CTA performed subsequently excluded this hypothesis. On the MRI, it became clear that it is a solid tumor with a highly cellular component, characterized by its hyperdense aspect on CT and marked restricted diffusion on DWI/ADC. 

The case was histologically proven as a primary CNS lymphoma (PCNSL). 

Typically PCNSL are supratentorial and appear as a mass or multiple masses that are usually in contact with the subarachnoid/ependymal surfaces. On CT most lesions are hyperattenuating and shows homogeneous enhancement. On MRI images, they are typically hypointense to white matter on T1, show strong homogeneous enhancement, iso to hypointense on T2, and with a typical restricted diffusion on DWI/ADC. 

 

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