Computer Assisted Tomography in Primary Malignant Lymphomas of the Brain

Cerebral lymphoma: clinical radiological correlation.

“…Kazner et al,16 and Tallroth25 found three basal ganglia and one suprasellar tumour in ten patients; Tadmor et al,'7 one lesion spreading through the corpus callosum and one basal ganglia tumour; and in fourteen cases, Enzmann et al'8 found involvement of the basal ganglia or corpus callosum in all six patients with multiple lesions and also in three of eight patients with solitary tumours. A subacutely developing "psycho-organic syndrome" with "somnolence" was the usual clinical presentation in these patients, but the authors did not emphasise the correlation with radiological localisation.…”

“…The high incidence of bone sclerosis renders sphenoid ridge meningiomas less frequently misdiagnosed.30 On the other hand, posterior fossa lymphoma is quite likely to be mistaken for a meningioma. 16 Overall, the particular localisation of most lymphomas and the subacute illness that usually results should combine to make the clinician wary. Those lymphomas that are not characteristically central, or are of mixed density without homogenous enhancement (table 7) simulate the appearance of gliomas.…”

“…[16][17][18] It therefore seemed important to determine whether a survey of the clinical features and CT appearances might enable one to improve on this, not least because "the most remarkable clinical feature of the tumours is their response to radiotherapy".' Many are multiple5 19 20 and so readily confused with metastases; because of the results of this confusion, in particular, it seemed important to decide whether any clinical or radiographic pattern would enable the clinician to recognise the possibility of this diagnosis and so encourage biopsy even in the seemingly "hopeless" case.…”

Onset of primary brain T-lymphoma simulating a progressive leukoencephalopathy

“…Our patient showed features suggesting an inflammatory or degenerative encephalopathy for seven months until nodular lesions appeared and a target biopsy could be performed. The CT scan often shows a nodular lesion, variably enhanced after contrast injection and with slightly increased attenuation values in the plain scan [9]; diffuse white matter edema is described in one patient by Merc.hut et al [11], and in only two by Bogdahn et al [3]. In the Bogdahn review [3] only 1 patients out of 83 cases gave an encephalitis-like picture with a positive CSF cytological examination; however, a progressive deterioration was reported in 2 out of 17 by Letendre [10], in 5 out of 19 by Freeman [4] and in 2 out of 8 by Bertoncelli [2].…”

“…Further, the evolution rarely clarifies the diagnosis, the tumor often being identified only after biopsy examination or autopsy [1,10]. The radiological findings are hydrocephalus or focal lesions diagnosed as meningiomas or gliomas [9], but such findings seldom lead to a suspicion of brain lymphoma. The histological and immunohistochemical investigations, on the other hand, clearly reveal the cellular features of brain lymphomas, leading to appropriate radiotherapy [1,2,5].…”