PRIMARY T-CELL CNS LYMPHOMA MIMICKING VASCULITIS. Issue 12 (15th November 2016)

• Record Type: Journal Article
• Authors: Raheem, Bazo; Khan, Hina; Scolding, Neil; Love, Seth; Al-Sarraj, Safa; Bhangoo, Ranj; Devereaux, Stephen; Rooney, Nicholas; Sutak, Judith; Moran, Nicholas
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 87:Issue 12(2016)
• Page Start: e1
• Page End: e1
• Publication Date: 2016-11-15
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2016-315106.193
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : A 29 year old male presented with headache and no neurological signs. MRI brain strongly suggested an aggressive primary brain tumour in the right frontal lobe but histopathology revealed a pleomorphic lymphoid infiltrate, necrosis and vague granulomata and vasculitis was diagnosed. There was aggressive clinico-radiological progression despite two debunking surgeries, corticosteroids and cyclophosphamide. On review the following were noted: areas of necrosis and focal diffuse lymphoid infiltrate showing perivascular cuffing; the presence of granuloma formation and vascular necrosis was less certain; overwhelming predominance of T-cells within the parenchyma; high T-cell mitotic activity and the mild nuclear atypia of the T-cells. PCR demonstrated no clonal immunoglobulin gene but showed a T-cell receptor gene rearrangements. The diagnosis was revised to primary T-cell CNS Lymphoma. Arabinoside & methotrexate were administered. Cerebral vasculitis may present with the imaging appearances of a malignancy. In the current case, a mass lesion was misdiagnosed as vasculitis due to atypical histopathology.