Presentation
History of acquired immunodeficiency syndrome (AIDS) undergoing treatment. Presents with bilateral frontal headache.
Patient Data
Right parieto-occipital cortical-subcortical parasagittal mass lesion involving the corpus callosal splenium, with extensive perilesional vasogenic edema. Similar if smaller left frontal cortical-based mass, also showing extensive perilesional vasogenic edema.
The lesion on the right causes a mass effect, with effacement of the third ventricle and occipital and temporal horns of the right ventricle, subfalcine herniation, and bilateral descending transtentorial herniation, best appreciated on coronal T2WI.
These cortical and subcortical masses show restricted diffusion, correlating with low ADC map signal (0.6x10-3 mm2/s) and intense homogeneous enhancement of the solid portions on contrast-enhanced T1WI.
Perfusion curves show an overshoot in the lesion (yellow) compared with normal brain parenchyma (blue), a common finding in lymphoma.
Intermediate echo time (TE 144) MRS demonstrates an increase in choline, with a decrease of N-acetylaspartate (NAA) and the presence of a lactate-lipid doublet, typical of lymphoma.
Case Discussion
The presence of low values on the ADC map, the perfusion overshooting mismatch, as well as the lipid and lactate doublet in MRS, are highly suggestive of lymphoma.
A biopsy of lesions was performed with the histopathologic report of large B-cell non-Hodgkin lymphoma, lymphoplasmacytic type.
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