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Atypical central nervous system lymphoma at the cranial base: report of four cases
S M Roman-Goldstein1, A Jones, J B Delashaw
1Department of Diagnostic Radiology, Oregon Health Sciences University, Portland 97201, USA.
Objective And Importance:
Primary central nervous system lymphoma is a disease with increasing incidence. Atypical presentations are becoming more frequent.
Clinical Presentation:
Three patients bearing cavernous sinus lesions presented initially with periorbital pain and diplopia. Tolosa-Hunt syndrome was the initial presumptive diagnosis for two patients, and meningioma was the diagnosis for the third patient. A fourth patient presented with left ear pain, and a mass in the left internal auditory canal was thought to represent an acoustic neuroma.
Intervention:
For all four patients, an operative pathological diagnosis was obtained and was compatible with central nervous system lymphoma. All patients were treated with osmotic blood-brain barrier disruption with intra-arterial chemotherapy using a methotrexate-based regimen.
Conclusion:
All four cases included atypical presentations of lymphoma. These cases again illustrate that a correct diagnosis cannot be obtained based only on imaging and clinical findings.