A Case of Primary T-Cell Central Nervous System Lymphoma: MR Imaging and MR Spectroscopy Assessment

Primary central nervous system lymphomas (PCNSLs) are mainly B-cells lymphomas. A risk factor for the development of PCNSL is immunodeficiency, which includes congenital disorders, iatrogenic immunosuppression, and HIV. The clinical course is rapidly fatal; these patients usually present signs of increased intracranial pressure, nausea, papilledema, vomiting, and neurological and neuropsychiatric symptoms. PCNSL may have a characteristic appearance on CT and MR imaging. DWI sequences and MR spectroscopy may help to differentiate CNS lymphomas from other brain lesions. In this paper, we report a case of a 23-year-old man with T-primary central nervous system lymphoma presenting with a mass in the right frontotemporal lobe. We describe clinical, CT, and MRI findings. Diagnosis was confirmed by stereotactic biopsy of the lesion. 1. Introduction PCNSL causes approximately 3%-4% of all primary brain tumors. PCNSL is defined as lymphoma in the central nervous System (CNS) without primary tumor elsewhere. PCNSL is mainly diffuse large B-cell lymphoma; less common PCNSL histological types are Burkitt’s lymphoma and T-cell lymphoma. Our case is about a 23-year old man with T-cell central nervous system lymphoma (T-PCNSL). 2. Clinical History A 23-year-old man was referred to our emergency room because of nausea, vomiting with associated acute confusional state. Neurological examination revealed slow response, postural instability without rigidity or tremor in any of the four extremities, and normal sensation. No remarkable abnormality was observed at the physical examination. Laboratory tests were within normal limits, in exception for LDH 61,1？mU/mL (5–36？mU/mL normal range). Past medical history was negative for considerable pathologies. HIV status of the patient was positive. Computed tomography (CT) of the brain revealed a ？cm mild hyperdense mass in the right frontotemporal region with associated perilesional oedema. Mild mass effect on the homolateral ventricle was observed with 1？cm midline shift. CT also revealed the presence of another similar lesion measuring 3,5？cm localized in the right cerebellar lobe (Figure 1). Figure 1: Axial CT acquisition (a)-(b) with sagittal (c) and coronal (d) multiplanar reformatted images showing a mild hyperdense complex lobulated mass in the right frontotemporal region associated with oedema and a similar smaller lesion in the right cerebellar lobe. In the next, CT scan was integrated with brain MRI and single-voxel (1)H MR spectroscopy. Diffusion weighted imaging (DWI) showed hyperintense lesions at the right