Fact-sheet: Lymphoma of brain
Updated on 04/20/2018 at 6:01 PM
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Definition
Primary central nervous system lymphomas account for 5% of brain tumors.
They are favored by immunosuppression (AIDS, immunosuppressive therapy), but the majority of cases occur in immunocompetent patients.
Clinical features
Focal neurologic deficits, variable depending on the location of the lesion.
Seizures
Headaches
Etc...
CT
Spontaneously iso- or hyperdense lesion (90%)
MRI
Predominance of supratentorial lesions (85%).
Lesion iso- or hypointense on T1 and T2 (75%).
Homogeneous enhancement (90%)
Absence of necrosis (90%).
Multiple lesions in 30% of cases.
Periventricular lesion (50%) (corpus callosum, subependymal infiltration, ventriculitis) or in contact with the leptomeninges.
Perilesional edema is generally mild and mass effect is often much less pronounced than with a malignant glioma or a metastasis.
MR spectroscopy: highly cellular, minimally or non-necrotic lesion on MRI: markedly elevated choline/creatine and choline/NAA ratios, associated with a prominent lipid resonance;
Perfusion MRI: characteristic first-pass curve, with a signal increase above baseline due to massive leakage of contrast agent into the interstitial space.
In immunocompromised patients, the radiologic features of PCNSL are polymorphic.
Management
Do not treat with corticosteroid therapy, which could cause transient disappearance of the lesions.
Confirm by CSF analysis and by screening for lymphomatous uveitis (slit lamp examination).
Differential diagnosis
Other brain tumors
Toxoplasmosis of brain (in immunocompromised patients)