Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(06): 557-558
DOI: 10.1590/0004-282X-anp-2020-0394
Images in Neurology

Sentinel inflammatory demyelinating lesions preceding primary CNS lymphoma

Lesões inflamatórias desmielinizantes sentinelas precedendo linfoma primário do SNC
Danielle Mesquita TORRES 
1   Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.
,
Milena Sales PITOMBEIRA 
1   Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.
,
Igor Bessa SANTIAGO 
1   Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.
,
Gabriela Joca MARTINS 
1   Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.
,
Kellen Paiva FERMON 
1   Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.
,
Daniel Gurgel Fernandes TAVORA 
1   Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.
,
Fernanda Martins Maia CARVALHO 
1   Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.
2   Universidade de Fortaleza, Programa de Pós Graduação em Ciências Médicas, Fortaleza CE, Brazil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

A 29-year-old man presented with acute seizures and visual impairment. Brain magnetic resonance imaging (MRI) showed multiple white matter T2-lesions with incomplete peripheral enhancement ([Figures 1A to 1C]). Considering the hypothesis of acute disseminated encephalomyelitis, intravenous methylprednisolone (IVMP) was administrated with full recovery. Two years later, he presented right-sided weakness. MRI disclosed a new T2-lesion, and spectroscopy suggested a tumefactive inflammatory pattern ([Figures 1D to 1H]). New extensive cerebrospinal fluid (CSF) and blood workup, including aquaporin-4-IgG, was unremarkable. Partial improvement was observed following IVMP. Six months later, after new weakness in the left arm along with a new periventricular lesion ([Figures 1I to 1L]), a brain biopsy was performed. Histopathological analysis revealed primary central nervous system (CNS) lymphoma ([Figure 2])[1],[2],[3].

Zoom Image
Figure 1 Magnetic resonance imaging exams. (A-C): first magnetic resonance imaging performed on March 2016 indicated diffusion restriction on diffusion-weighted image (A), T2 hypersignal (B), and peripheral enhancement on post-contrast T1 sequences (C). D-H: Neuroimaging performed on July 2018 showed a new lesion with peripheral restricted diffusion on diffusion-weighted image (D), T2 hypersignal (E), thick annular enhancement (F), spectroscopy revealed Cho peak increase (G) and minimal relative cerebral blood volume map (rCBV) increase. (H). (I-L): Brain magnetic resonance imaging performed on January 2019 disclosed a new right periventricular lesion with diffusion restriction on diffusion-weighted image (I), mild T2 hyperintensity sequences (J), and homogeneous contrast enhancement (L).
Zoom Image
Figure 2 Histopathological examination showed atypical lymphoid cell proliferation.

Authors’ contributions:

DT: literature review, manuscript and imaging preparation, IS: literature review, manuscript preparation; MSP, GJ, KF and FMM: manuscript supervision and revision.




Publication History

Received: 04 September 2020

Accepted: 25 September 2020

Article published online:
04 July 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Mark DK, Deva S, Rudolph J, Castellani RE, Morales SG, Reichs ASK, Robert KS. Demyelination as a harbinger of lymphoma: a case report and review of primary central nervous system lymphoma preceded by multifocal sentinel demyelination. BMC Neurol. 2016 May;16-72. https://doi.org/10.1186/s12883-016-0596-1
  • 2 Chiavazza A, Pellerino F, Ferrio A, Cistaro R, Soffietti R, Rudà R. Primary CNS lymphomas: challenges in diagnosis and monitoring. Biomed Res Int. 2018 Jun;3606970. https://doi.org/10.1155/2018/3606970
  • 3 Jian-Giang Lu, Cian O’Kelly, Safwat G, Derek E, Christopher P, Gregg B. Neuroinflammation preceding and accompanying central nervous system lymphoma: case study and literature review. World Neurosurg. 2016 Apr;88:692.e1-692.e8. https://doi.org/10.1016/j.wneu.2015.11.099