Case report: Ventricular primary central nervous system lymphoma with partial hypointensity on diffusion-weighted...

Area of Science:

• Neuro-oncology
• Radiology
• Pathology

Background:

• Primary central nervous system lymphoma (PCNSL) constitutes a small fraction of primary brain tumors.
• Ventricular involvement, especially in the third ventricle, is exceptionally rare, with limited existing literature.
• Accurate diagnosis is crucial due to distinct treatment protocols for PCNSL compared to other brain tumors.

Observation:

• A 78-year-old male presented with cognitive decline and unresponsiveness.
• MRI revealed lesions in the third and left lateral ventricles with specific signal characteristics on T1WI, T2WI, and DWI.
• The third ventricular lesion showed hypointensity on DWI, an atypical finding for PCNSL.

Findings:

• Pathology confirmed diffuse large B-cell lymphoma (DLBCL) as the cause of the ventricular lesions.
• The study reviewed 20 years of case reports on ventricular PCNSL, analyzing imaging presentations.
• Differentiating ventricular PCNSL from other tumors with similar imaging is essential.

Implications:

• Recognizing atypical imaging features of ventricular PCNSL is critical for timely diagnosis.
• This case underscores the importance of considering PCNSL in the differential diagnosis of intraventricular lesions.
• Appropriate management planning hinges on distinguishing PCNSL due to its unique therapeutic strategies, primarily chemotherapy and radiation.