Pathologically Proven Gadolinium-enhanced MRI Lesions in the Bilateral Corticospinal Tracts in Lymphomatosis Cerebri

Abstract

A 78-year-old woman in complete remission of mass-forming primary central nervous system lymphoma (PCNSL) showed diffuse leukoencephalopathy as well as corticospinal tract lesions with intense gadolinium enhancement on magnetic resonance imaging (MRI). She died 3 months later. In line with the MRI findings, pathological examination revealed dense infiltration of atypical lymphoid cells, consistent with a diagnosis of lymphomatosis cerebri (LC)-type PCNSL. This is the first report of LC in which the corticospinal tracts demonstrated robust contrast enhancement directly corresponding to the neuropathological findings, and it is also a rare instance in which LC presented as a recurrence of typical PCNSL.

Keywords: corticospinal tracts; diffuse large B-cell lymphoma; gadolinium-enhanced lesions; lymphomatosis cerebri; pathological findings; recurrence.

Figure 1.

Findings on magnetic resonance imaging. (a, b) 73 years, (c, d, e) 78 years, (f) 1 month prior to death. (a) Hyperintense lesion in the right temporal lobe on a FLAIR image. (b) Gadolinium-enhancing mass lesion in the right temporal lobe on a T1-weighted image. (c) Diffuse hyperintensities in the left frontal lobe and bilateral diencephalon, and old lesions in the right temporal and frontal lobes on a T2-weighted image. (d) Hyperintense signals in the bilateral corticospinal tracts on a coronal FLAIR image. (e) Gadolinium-enhancing bilateral corticospinal lesions on a coronal T1-weighted image. (f) Diffuse hyperintensities in the bilateral cerebral hemispheres, sparing the left occipital lobe, on a FLAIR image. FLAIR: fluid-attenuated inversion recovery

Figure 2.

Pathological findings. (a) Atypical lymphoid cells with large and irregularly shaped nuclei are densely infiltrating the corticospinal tracts [Hematoxylin and Eosin (H&E) staining]. (b) Neoplastic lymphoid cells are positive for CD20. (c) A few reactive T cells positive for CD3 are observed around neoplastic B cells. (d) Scattered neoplastic lymphoid cells are observed in the left occipital lobe around the calcarine sulcus (H&E staining).