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

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.

Neuroradiological features of lymphomatosis cerebri: A systematic review of the English literature with a new case report

“…Non-enhanced T 1 WI as used for 13 patients in the systematic review, of which 6 cases were presented as isointensity and 7 cases were hypointensity. DWI results were described for 14 patients in the present systematic review, of which the lesion signals were isointense in 2 cases ( 34 , 39 ), slightly hyperintense in 11 cases (including the present case) ( 14 , 20 , 26 , 28 , 29 , 32 , 47 , 48 , 50 ) and highly hyperintense in 1 case ( 24 ) compared with the normal gray matter.…”

“…The lesions involved the corpus callosum in 19 cases (42.2%), the basal ganglia in 15 cases (33.3%), the thalamus in 12 cases (26.7%), the midbrain in 21 cases (46.7%), the pons in 20 cases (44.5%), the medulla in 14 cases (31.1%), the cerebellum in 12 cases (26.6%) and the spinal cord in 5 cases (11.1%) ( Table II ). Lesions were also observed in the cerebral ( 20 , 28 , 41 , 43 , 50 ) and cerebellar ( 35 , 41 ) cortices, and the cerebellar dentate nuclei ( 30 ).…”

Lymphomatosis cerebri mimicking iatrogenic Creutzfeldt-Jakob disease

“…Lumbar puncture examination revealed non-specific raised white cell count and an elevated protein. Definite diagnosis was achieved via biopsy with positive staining (for CD3, CD45, CD10, CD99) confirming primary CNS T-cell lymphoma 16. Despite treatment with intrathecal and intravenous methotrexate-based chemotherapy with initial clinical and radiological improvement, the patient subsequently died of the disease 15 months after discharge.…”

“…Common side effects of polychemotherapy include acute hepatotoxicity, nephrotoxicity, anaemia, thrombocytopaenia and maintenance of remission in elderly patients 15. High-dose whole-brain radiation therapy (WBRT) is no longer part of first-line treatment due to the propensity of inducing late neurotoxicity with most patients relapsing 13 16. Radiation therapy has a role if there is a recurrence or lack of response to primary therapy 14.…”

Primary dural lymphoblastic B-cell lymphoma: a rare subtype of aggressive dural lymphoma

“…The majority of PDL are low-grade, B-cell marginal zone lymphoma (MZL) with rare cases of low-grade follicular subtypes reported [1]. Aggressive dural lymphomas including diffuse large B-cell lymphoma (DLBCL) and lymphoblastic subtypes are limited to case reports and small case series [1,[3][4][5][6] ( Table 1). PDL have favorable outcomes and the indolent forms are biologically distinct from parenchymal PCNSL or systemic lymphoma metastatic to the CNS [1].…”