Primary infratentorial diffuse large b-cell lymphoma: a challenging diagnosis in an immunocompetent patient

Abstract

SUMMARY We describe the case of a female patient, 52 years old, with dizziness and left motor incoordination for 2 weeks. Brain MRI magnetic resonance imaging) revealed a hyperintense lesion on T2-weighted images, without restricted diffusion, in the left middle cerebellar peduncle. Spectroscopy demonstrated peak of lipids and perfusion did not show any elevation in relative cerebral blood volume (rCBV). The patient underwent an open biopsy and resection, and the diagnosis of diffuse large B-cell lymphoma (DLBCL) was established. The patient received intravenous dexamethasone with symptoms remission, followed by four cycles of methotrexate plus cytarabine. After 3 months, the patient returned with decreased consciences level and a new MRI revealed a right superior frontal gyrus lesion with features suggesting a lymphomatous lesion. The patient died five days after her relapse.

Branch-like enhancement on contrast enhanced MRI is a specific finding of cerebellar lymphoma compared with other pathologies

“…Therefore, we focused on the novelty of the feature of BLE. A search of the literature for CL with contrast-enhanced MRI images confirms this finding in many cases, even though it has not been reported as BLE 20 , 23 – 25 . The earliest report of MRI findings in CL reported an unusual enhancement pattern with detailed comparison to pathology 20 .…”

Common and uncommon neuroimaging manifestations of ataxia: an illustrated guide for the trainee radiologist. Part 2 - neoplastic, congenital, degenerative, and hereditary diseases

“…On computed tomography, classic medulloblastomas appear as hyperattenuating masses, usually located along the midline and with contrast enhancement (9,10) . On MRI (Figure 2), they show restricted diffusion and variable enhancement, a pattern that can mimic cerebellar lymphoma (12,13) . Intralesional cysts can be found (8)(9)(10)(11) .…”