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Hemorrhagic Presentation in Primary Central Nervous System Lymphoma: A Case Study
Filipa Marques Rodrigues1, Mariana Santos2, Ricardo Martins2
1Department of Internal Medicine, Hospital de Braga, Braga, Portugal.
The American Journal of Case Reports
|April 2, 2024
Summary
Primary central nervous system diffuse large B-cell lymphoma (DLBCL) rarely presents with hemorrhage in young, immunocompetent patients. Brain MRI is crucial for diagnosing this aggressive brain lymphoma, aiding differentiation from other lesions.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Primary central nervous system diffuse large B-cell lymphoma (DLBCL) is a rare and aggressive brain malignancy.
- It infrequently affects non-elderly, immunocompetent individuals, and hemorrhagic presentation is exceptionally uncommon.
Observation:
- A 44-year-old man presented with persistent headaches, disorientation, and incoherent speech.
- Initial CT revealed a space-occupying lesion with hemorrhage; MRI showed restricted diffusion and contrast enhancement, indicative of a hypercellular lesion with bleeding.
Findings:
- Brain biopsy confirmed primary central nervous system diffuse large B-cell lymphoma (DLBCL) with a germinal center phenotype.
- The case highlights a rare hemorrhagic manifestation of this aggressive brain tumor in a young, immunocompetent patient.
Implications:
- Hemorrhagic presentation of CNS DLBCL is rare in this demographic, necessitating high clinical suspicion.
- Brain MRI findings, including restricted diffusion and T2 hypointensity, are vital for differentiating CNS DLBCL from other brain lesions, especially those with hemorrhage.
- Early suspicion of lymphoma is critical for appropriate management and surgical planning.
