Metastatic CNS lymphoma presenting with periventricular dissemination — MRI and neuropathological findings in an autopsy case
Introduction
In 5–9% of systemic non-Hodgkin's lymphoma, secondary involvement is seen in the CNS, and usually manifests as pachymeningeal or leptomeningeal infiltrates [1], [2]. Parenchymal lesions, when present, typically result from secondary involvement from the leptomeninges [1]. Here, we report an autopsy case of metastatic CNS lymphoma showing an unusual distribution.
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Case report
A 70-year-old man had noticed a mass in the left supraclavicular fossa, but did not consult a hospital. About 1 month later, he presented with bilateral parkinsonism including gait disturbance, akinesia, mask-like face, and dysphagia. He was admitted to our hospital about 3 months after the onset. Physical examination on admission demonstrated consciousness disturbance with Glasgow Coma Scale (GCS) of 12 (E3 V4 M5), swelling of the left supraclavicular lymph nodes, measured approximately 4 by
Discussion
We demonstrated periventricular involvement on MRI, and periventricular dissemination of lymphoma cells on postmortem study in a patient with systemic lymphoma. The enhancement with contrast medium is usually due to a breakdown of the blood-brain barrier (BBB). In our case, periventricular lesions included vascular proliferation probably associated with tumor neovascularity. Because the abnormal vessels had no effective BBB, the periventricular areas were distinctly enhanced by contrast medium.
Acknowledgement
This work was supported by a grant-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology (14570957) and a research grant from the Zikei Institute of Psychiatry.
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