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Images in Neurology |

Magnetic Resonance Imaging Observations in Primary Central Nervous System Lymphoma

Justin T. Jordan, MD1; Scott Plotkin, MD, PhD1; Jorg Dietrich, MD, PhD1
[+] Author Affiliations
1Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston
JAMA Neurol. 2014;71(7):918-919. doi:10.1001/jamaneurol.2014.70.
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A 63-year-old woman with no medical history presented with two weeks of personality changes and social withdrawal, ignoring family, friends, and work. There were no apparent hallucinations or delusions. Her son brought her for evaluation after she began having difficulty recalling personal information and family names.

On examination, the patient was awake but inattentive, with a flat affect and no spontaneous speech. With prompting, all components of her language were otherwise normal. Her concentration was poor, as was remote and working memory. Her examination was otherwise normal for cranial nerves, strength, sensation, coordination, balance, and gait. Magnetic resonance imaging of the brain showed a symmetric enhancing lesion in the bilateral frontal lobes and anterior corpus callosum (Figure 1).

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Figure 1.
Magnetic Resonance Imaging of the Brain

A, T2/fluid-attenuated inversion recovery symmetric hyperintensities are seen in the bilateral frontal lobes with callosal and forniceal thickening. B, Post-gadolinium T1-weighted images show homogeneous enhancement on coronal images. C, Restricted diffusion is seen on diffusion-weighted imaging. D, Apparent diffusion map hypointensity confirms restricted diffusion.

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Figure 2.
Stereotactic Biopsy of Brain Lesion Demonstrates Diffuse Large B-cell Lymphoma

A and B, Hematoxylin-eosin stain (original magnification x10 [A] and x40 [B]) of biopsy shows hypercellular, infiltrative characteristic. C, Tumor stains positively for CD-20.

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