CASE 2306 Published on 27.02.2004

Primary low-grade B-cell lymphoma.

Section

Neuroradiology

Case Type

Clinical Cases

Authors

Guelbenzu S, Ros Mendoza L, Marín MA, Mayayo E

Patient

34 years, male

Categories

No Area of Interest ; Imaging Technique CT, MR, MR-Angiography

No Procedure ; No Special Focus ;

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Clinical History

Intense migraine.

Imaging Findings

Intense right headache (migraine) and disestesias on the left hemibody.

Discussion

This is a rare entity, particularly in this location. Being a dural and extra-axial mass, the first differential diagnosis to be established is that of a meningioma. The semiological criteria of a dural mass would be compatible, but there is no increase of the meningeal vascularization nor involvement of the inner table of the skull, so osteosarcoma or metastasis, which typically involve this structure could, also, be disregarded. The possibility of a subdural hematoma is not compatible, given that, although the semiological criteria are similar to these of an acute subdural hematoma in the precontrast computed tomographic images, after intravenous contrast administration the lesion presents a very intense enhancement. The possibility of a peridural abscess could be considered, but the clinical manifestations, absence of fever, are not concordant. In order to establish the diagnosis of lymphoma, it is important to consider the enhancing bands oriented towards the brain parenchyma.They correspond to an infiltration of the sulci or, even, to an infiltration of Virchow-Robin perivascular spaces, finding that is more common in this kind of pathology than in other tumors.

Differential Diagnosis List

Primary low-grade B-cell lymphoma.

Final Diagnosis

Primary low-grade B-cell lymphoma.

References

[1] Nakano T, Asano K, Miura H, Itoh S, Suzuki S.
Meningiomas with brain edema. Radiological characteristics on MRI and review of the literature.
Clin Imaging 2002, Jul-Aug; 26 ( 4 ): 243-249. (PMID: 12140153)

[2] Goetz P, Lafuente J, Revess T, Galloway M, Dogan A, Kitchen.
Primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue of the dura mimicking the presentation of an acute subdural hematoma.
N. J Neurosurg 2002. Mar ; 96 ( 3 ) 611-614. (PMID: 11883850)

[3] Coulon A, Lafitte F, Hoang-Xuan K, Martin-Duverneuil N, Mokhtari K, Blustajan J, Chiras J.
Radiographic findings in 37 cases of primary CNS lymphoma in inmunocompetent patients.
Eur Radiol 2002 Feb; 12 ( 2 ): 329-340. (PMID: 11870430)

[4] Buhring U, Herrlinger U, Krings T, Thiex R, Weller M, Kuker W.
MRI features of primary central nervous system lymphomas at presentation.
Neurology 2001 Aug 14; 57 ( 3 ): 393-396. (PMID: 11515505)

[5] Herrlinger U, Schabet M, Brugger W, et al.
Primary CNS lymphoma 19911997: outcome and late adverse effects after combined modality treatment.
Cancer . 2001; 91: 130135. (PMID: 11148569)

Case information

URL:	https://www.eurorad.org/case/2306
DOI:	10.1594/EURORAD/CASE.2306
ISSN:	1563-4086

Figure 1

Computed tomography

Computed tomography, without intravenous contrast administration. There was a slightly hyperdense mass on the right parietal area without displacement of the cerebral middle line.

After intravenous contrast administration an uniform and intense contrast captation of the extra--axial lesion is seen.(Images 1b, 1c, 1d)

Figure 2

MRI of the brain

Axial, proton density image: the extra-axial mass presented a high and uniform signal.

Axial, T2 weighted image:the lesion presented an intense hypersignal. There was also a signal increase on the adjacent cortical sulci.

Coronal T1 weighted image: the parietal mass appeared isointense

Coronal T1 weighted images after intravenous administration of gadolinium (images 2d,2e):There was an uniform increase of the intensity of the mass signal, with enhancing bands oriented towards the brain parenchyma.

Figure 3

Angio MR