Case Report

Acta Neurochirurgica

, Volume 152, Issue 1, pp 163-168

Open Access This content is freely available online to anyone, anywhere at any time.

Primary brain T-cell lymphoma of the lymphoblastic type presenting as altered mental status

  • Aaron J. ClarkAffiliated withDeparment of Neurosurgery, Virginia Commonwealth University Medical CenterDepartment of Neurological Surgery, University of California, San Francisco Email author 
  • , Kangmin LeeAffiliated withDeparment of Neurosurgery, Virginia Commonwealth University Medical Center
  • , William C. BroaddusAffiliated withDeparment of Neurosurgery, Virginia Commonwealth University Medical Center
  • , Mary Jo MartinAffiliated withDepartment of Pathology, Virginia Commonwealth University Medical Center
  • , Nitya R. GhatakAffiliated withDepartment of Pathology, Virginia Commonwealth University Medical Center
  • , Catherine E. GrossmanAffiliated withDepartment of Hematology and Oncology, Virginia Commonwealth University Medical Center
  • , Sherman BakerJr.Affiliated withDepartment of Hematology and Oncology, Virginia Commonwealth University Medical Center
  • , Ahmet BaykalAffiliated withDepartment of Radiology, Virginia Commonwealth University Medical Center

Abstract

The authors present a case of a 56-year-old man with altered mental status. Magnetic resonance imaging (MRI) of the brain revealed non-enhancing abnormalities on T2 and FLAIR imaging in the brainstem, cerebellum, and cerebrum. Immunohistochemisty demonstrated precursor T-cell lymphoblastic lymphoma. After treatment with methotrexate, he improved clinically without focal sensorimotor deficits and with improving orientation. MRI showed almost complete resolution of brainstem and cerebral lesions. To the authors’ knowledge, there are only five previous reports of primary central nervous system T-cell lymphoblastic lymphoma. Since treatable, it deserves consideration in patients with altered mental status and imaging abnormalities that include diffuse, non-enhancing changes with increased signal on T2-weighted images.

Keywords

T-cell lymphoblastic lymphoma Primary CNS lymphoma Brain tumor Altered mental status Chemotherapy