CNS Involvement of DLBCL Presenting with an Unusual Non-Enhancing Infiltrative Mass

Abstract

Central nervous system (CNS) involvement in diffuse large B-cell lymphoma (DLBCL) is relatively uncommon, occurring in approximately 5% of cases, with the majority of instances manifesting during relapse and often associated with poor prognoses. The aim of this case report is to present a unique occurrence of non-enhancing relapse of CNS lymphoma. Significantly, the patient had recently encountered a disease involvement in the axilla region, and subsequent to scheduled chemotherapy, she developed persistent neurological symptoms, leading to the discovery of a relapse of the CNS lymphoma. Our focus will be on delineating the clinical presentation, elucidating the findings observed in clinical imaging, and detailing the therapeutic approaches employed in this specific case. By highlighting these aspects, we aim to provide valuable insights into the diagnosis of the atypical presentation of CNS lymphoma.

Keywords: CNS lymphoma; CT; MRI.

Figure 1

Non-contrast CT scan of brain. The images show a hypointense area with brain swelling at left frontal lobe (A), left basal ganglion (B), left thalamus (B) and left cerebral peduncle (C).

Figure 2

MRI performed three days after CT scan. MRI fused images of axial T2WI, FLAIR, T1WI, Gd-T1WI, ADC, and DWI images. Abnormal hyperintense lesions are seen at left frontal lobe, left parietal lobe, bilateral corona radiata, bilateral basal ganglia, bilateral thalami on FLAIR, DWI, and ADC images. No obvious contrast enhancement or restricted diffusion is seen.

Figure 3

MR spectrocopy focusing on left basal ganglion lesion. Elevated choline peak and decreased N-acetylaspartate peak, with the presence of a lactate peak were found.