Correlation of computed tomography with the histopathology of primary malignant lymphoma of the brain

The authors present seven autopsy cases of non-AIDS primary malignant lymphoma of the central nervous system to correlate the pathology with the findings of the most recent pre-mortem computed tomogram (CT). Of 10 primary contrast-enhancing (CE) lesions treated by chemotherapy alone, radiotherapy alone, radiochemotherapy, or surgery combined with radiochemotherapy, all but one completely disappeared after the initial course of therapy. However, in six of the seven patients, the final pre-mortem CT demonstrated CE lesions. In three cases CE lesions were at the same site as the primary lesion, in one case in a remote location, and in two cases in diffuse and multiple locations. In all but one case these CE lesions corresponded histologically to tumor nodules or to white matter densely infiltrated by tumor cells. The sole exception was diagnosed pathologically as delayed radiation necrosis. The final CT also showed five low-density areas (LDAs) which had evolved from CE lesions after the completion of therapy. These LDAs corresponded to rarefied or necrotic parenchyma in which tumor cells remained, mainly in the perivascular spaces. One case exhibited diffuse tumor infiltration of periventricular structures which appeared to have normal density and no CE on the final pre-mortem CT.