Primary Central Nervous System Lymphoma Presenting as Growing Intracerebral Hemorrhage

Hemorrhage at presentation in primary central nervous system (CNS) lymphoma is rare. We encountered a case of primary CNS lymphoma presenting as a growing intracerebral hemorrhage.

An 80-year-old man presented with mild dysarthria. Computed tomography demonstrated a round, high-density mass with surrounding vasogenic edema in the left frontal lobe. Although the patient was placed on antihypertensive therapy for suspected subacute subcortical hemorrhage, neurologic symptoms gradually worsened. Computed tomography after 2 weeks revealed that the high-density lesion and surrounding edema had increased in size compared with previous images. The patient had been transferred to our hospital 14 days after admission to another institution. Magnetic resonance imaging demonstrated a mass lesion comprising hemorrhage of different phases in the left frontal lobe. Contrast-enhanced T1-weighted imaging demonstrated a mass lesion with heterogeneous enhancement in the left frontal lobe. The patient underwent craniotomy with gross total removal of the hemorrhagic lesion. The histopathologic diagnosis was diffuse large-cell non-Hodgkin lymphoma, and immunohistochemistry showed high immunoreactivity for vascular endothelial growth factor.

Although exceedingly rare, primary central nervous system lymphoma can present as growing intracerebral hemorrhage due to repeated intratumoral hemorrhages. High expression of vascular endothelial growth factor and the mass effects of hemorrhage could be associated with the onset and growth of intracerebral hemorrhage. Early evaluation and meticulous observation are important to avoid progressive, life-threatening situations in such cases.