Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2020; 8(15): 3329-3333
Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3329
Imaging of hemorrhagic primary central nervous system lymphoma: A case report
Ya-Wei Wu, Jin Zheng, Lu-Lu Liu, Jun-Hui Cai, Hu Yuan, Jing Ye
Ya-Wei Wu, Jin Zheng, Lu-Lu Liu, Jun-Hui Cai, Hu Yuan, Jing Ye, Department of Radiology, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China
Author contributions: Wu YW reviewed the literature and contributed to manuscript drafting; Zheng J and Ye J analyzed and interpreted the imaging findings; Liu LL, Cai JH and Yuan H contributed to manuscript editing; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jing Ye, MD, PhD, Assistant Professor, Doctor, Department of Radiology, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China. yejing_yzu@163.com
Received: April 7, 2020
Peer-review started: April 7, 2020
First decision: June 8, 2020
Revised: June 21, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: August 6, 2020
Abstract
BACKGROUND

A primary central nervous system lymphoma (PCNSL) presenting with massive hemorrhage is a rare occurrence that is difficult to distinguish from a high-grade glioblastoma. Comprehensive descriptions of the imaging characteristics of such tumors have not yet been reported. Herein, we reported a case of a PCNSL with massive hemorrhage by presenting the imaging features of computed tomography (CT) imaging and structural and perfusion magnetic resonance imaging (MRI).

CASE SUMMARY

A 48-year-old man presented with headache lasting for 10 d. CT of the brain showed a round, heterogeneous, high-density lesion with surrounding edema in the right temporal lobe. For further diagnosis, a series of MRI examinations of the brain were subsequently performed, and a hemorrhagic lesion with ring-like enhancement was determined. The whole lesion was relatively hypoperfused on arterial spin labeling images. Surgical resection of the lesion and histopathological examination confirmed that the lesion was a diffuse large B-cell lymphoma with massive hemorrhage.

CONCLUSION

PCNSLs with hemorrhage occur very rarely, and structural and perfusion MRI examinations are requested exceedingly rarely. This case provided insight into some characteristics of a hemorrhagic lymphoma on CT and MRI examinations. Perfusion MRI examination may be useful for the differential diagnosis of PCNSLs and other brain tumors.

Keywords: Primary central nervous system lymphoma, Massive hemorrhage, Perfusion, Multimodal magnetic resonance imaging, Lymphoma, Case report

Core tip: Primary central nervous system lymphoma (PCNSL) presenting with massive hemorrhage is a rare occurrence that is difficult to distinguish from a high-grade glioblastoma. Little is known about its imaging features, especially multimodal magnetic resonance imaging (MRI) findings. Here, we report on the computed tomography and MRI findings of PCNSL in a 48-year-old man. To the best of our knowledge, this is the first report with detailed computed tomography and MRI findings in hemorrhagic PCNSL and could provide useful information for the preoperative diagnosis.