Abstract
‘Lymphomatosis cerebri’ (LC) is a term indicating a diffusely infiltrating form of primary central nervous system lymphoma (PCNSL) without evidence of a mass lesion. Not infrequently, diagnostic confusion is caused by its presentation on cranial magnetic resonance images (MRI), which is characterized by diffuse leukoencephalopathy without contrast enhancement. In this report, we describe a 53-year-old, immunocompetent man who had an insidiously progressive dementia and right weakness. On serial MRI in 4 months duration, diffuse white matter lesions without contrast enhancement gradually progressed, which was clinically consistent with his worsening condition. Biopsy specimen demonstrated nondestructive, diffusely infiltrating, large B-cell lymphoma, diagnosing LC. After the biopsy, corticosteroids were initiated, which dramatically alleviated his symptoms. Afterwards, he was treated by whole brain irradiation (total 36Gy) and discharged without noticeable deficits. Diagnosis of LC requires additional examinations generally not performed in the other white matter disorders. In suspected cases, biopsy should be performed to avoid deferring adequate cytostatic treatment.
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References
Schwaighofer BW, Hesselink JR, Press GA et al (1989) Primary intracranial CNS lymphoma: MR manifestations. AJNR Am J Neuroradiol 10:725–729
Poon T, Matoso I, Tchertkoff V et al (1989) CT features of primary cerebral lymphoma in AIDS and Non-AIDS patients. J Comput Assist Tomogr 13:6–9
DeAngelis LM (1994) Primary central nervous system lymphoma. Recent Results Cancer Res 135:155–169
Thurnher MM, Rieger A, Kleibl-Popov C et al (2001) Primary central nervous system lymphoma in AIDS: a wider spectrum of CT and MRI findings. Neuroradiology 43:29–35
Buhring U, Herrlinger U, Krings T et al (2001) MRI features of primary central nervous system lymphomas at presentation. Neurology 57:393–396
Kuker W, Nagele T, Korfel A et al (2005) Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients. J Neurooncol 72:169–177
Bakshi R, Mazziotta JC, Mischel PS et al (1999) Lymphomatosis cerebri presenting as a rapidly progressive dementia: clinical, neuroimaging and pathologic findings. Dement Geriatr Cogn Disord 10:152–157
Kleihues P, Cavenee WK (eds) (2000) Pathology and genetics of tumours of the nervous system. International Agency for Research on Cancer (IARC) Press, Lyon
Rollins KE, Kleinschmidt-DeMasters BK, Corboy JR et al (2005) Lymphomatosis cerebri as a cause of white matter dementia. Hum Pathol 36:282–290
Lewerenz J, Ding X, Matschke J et al (2007) Dementia and leukoencephalopathy due to lymphomatosis cerebri. J Neurol Neurosurg Psychiatry 78:777–778
Terae S, Ogata A (1996) Nonenhancing primary central nervous system lymphoma. Neuroradiology 38:34–37
Carlson BA (1996) Rapidly progressive dementia caused by nonenhancing primary lymphoma of the central nervous system. AJNR Am J Neuroradiol 17:1695–1697
Furusawa T, Okamoto K, Ito J et al (1998) Primary central nervous system lymphoma presenting as diffuse cerebral infiltration. Radiat Med 16:137–140
DeAngelis LM (1993) Cerebral lymphoma presenting as a nonenhancing lesion on computed tomographic/magnetic resonance scan. Ann Neurol 33:308–311
Matsumoto K, Kohmura E, Fujita T et al (1995) Recurrent primary central nervous system lymphoma mimicking neurodegenerative disease-an autopsy case report. Neurol Med Chir (Tokyo) 35:360–363
Vaquero J, Martinez R, Rossi E et al (1984) Primary cerebral lymphoma: the “ghost tumor”. J Neurosurg 60:174–176
Partap S, Spence AM (2006) Spontaneously relapsing and remitting primary CNS lymphoma in an immunocompetent 45-year-old man. J Neurooncol 80:305–307
Acknowledgements
We greatly appreciate Drs. Yoichi Nakazato and Atsushi Sasaki (Department of Human Pathology, Gunma University Graduate School of Medicine, Gunma, Japan) for providing specimens immunohistochemically stained for Iba-1 and CD68, and their valuable scientific support.
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Kanai, R., Shibuya, M., Hata, T. et al. A case of ‘lymphomatosis cerebri’ diagnosed in an early phase and treated by whole brain radiation: case report and literature review. J Neurooncol 86, 83–88 (2008). https://doi.org/10.1007/s11060-007-9437-9
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DOI: https://doi.org/10.1007/s11060-007-9437-9