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Primary CNS lymphoma

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  • 70-year-old patient presented with a 3 week history of headaches.
  • CT showed a grossly enlarged and subtly hyperattenuating splenium.
  • On MRI, the lesion enhanced homogeneously with diffusion restriction.

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  • A 70-year-old patient presented with confusion and visual disturbance.
  • CT showed a hyperdense lesion involving the parietal white matter and corpus callosum.
  • Relative hypointensity on T2 and low values on ADC also indicated hypercellularity.
  • Alongside confluent avid enhancement, the imaging was typical for the final diagnosis of PCNSL.

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  • A 40-year-old patient presented with agitation and aggressive behaviour.
  • MRI showed mutliple lesions, some of which caused diffusion restriction (internal capsules) and some of which enhanced (right hemipons).
  • A diagnosis was not secured even after extensive investigation. The lesions responded to a trial of steroid therapy.
  • 3 years later, the patient presented following a seizure. MRI showed marked progression with an infiltative and enhancing lesion in the brainstem and new frontal lobe lesions.
  • Biopsy of a right frontal lesion revealed a diffuse large B-cell lymphoma, which again showed a response to therapy.