Necrotic Primary CNS Lymphoma in an Immunocompetent Patient: A Case Report and Literature Review

Primary lymphoma that arises de novo from the central nervous system (CNS) is most commonly a Non-Hodgkin’s B cell lymphoma and by definition lacks the presence of disease outside the CNS. It demonstrates characteristic imaging aspects on computed tomography (CT) and magnetic resonance imaging (MRI) exams related to its inherent hyper cellularity. On CT, primary CNS lymphoma demonstrates hyperdense attenuation and on MRI it commonly demonstrates restricted water diffusion on diffusion weighted sequences and homogeneous enhancement on post-contrast sequences. We present a case of primary CNS lymphoma in an immunocompetent patient with progressive necrosis and loss of restricted diffusion on diffusion weighted imaging with an atypical enhancement pattern. We further provide a review of the literature regarding the CT and MRI characteristics of primary CNS lymphoma and discuss the role of immune status in determining the imaging characteristics of this disease process.

Author(s): Peter Fiester, Patrick Natter, Dinesh Rao, Jeet Patel and Dalys Castro

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