Lymphoma, a great imitator in neurology

Area of Science:

• Neurology
• Oncology
• Pathology

Background:

• Lymphoma is often termed the "great imitator" due to its diverse clinical presentations.
• This condition can mimic a wide range of other diseases, complicating diagnosis and treatment.
• Neurological dysfunction is a significant, though sometimes overlooked, manifestation of lymphoma.

Observation:

• Three distinct cases of lymphoma presenting with neurological symptoms are detailed.
• Case 1: Burkitt lymphoma mimicking sarcoidosis with diplopia and gait disturbance.
• Case 2: Intravascular lymphoma presenting as stroke-like symptoms with cerebral infarcts.
• Case 3: Recurrent Burkitt lymphoma mimicking meningitis with leptomeningeal disease.

Findings:

• Lymphoma's varied presentations can mimic infective, inflammatory, granulomatous (e.g., sarcoidosis), and other neoplastic conditions.
• Elevated serum ACE levels are not definitive for sarcoidosis; histological confirmation is essential.
• Diagnosis was confirmed through biopsy (Burkitt lymphoma), skin biopsy (intravascular lymphoma), and PET-CT (relapsed Burkitt lymphoma).

Implications:

• The diagnostic uncertainty highlights the need to consider lymphoma in patients with unexplained neurological deficits.
• Histological examination remains the gold standard for diagnosing lymphoma, even when other markers are suggestive of different conditions.
• Early recognition of lymphoma as a potential mimic is critical for appropriate management and improved patient outcomes.