A Rare Case of Peripheral T cell Lymphoma Presenting as a Solitary Brain Mass in an Immunocompetent Patient with Atypical Imaging Features
Yoon Choi1, Xiao-Tang Kong2
1University of California, Irvine, 2UC Irvine
Objective:
To present a rare case of peripehral T cell lymphoma presenting as a solitary brain mass in an immunocompetent patient with atypical imaging features.
Background:
Peripheral T cell lymphoma presenting as a solitary brain mass is rare. Brain MRI(Magnetic Resonance Imaging) findings of CNS(Central Nervous System) lymphoma differ depending on the patient’s immune status. In immunocompetent patients, typical lymphoma lesions show solitary, well-defined, and homogeneously enhancing lesions. Diffusion restriction is common, necrosis and hemorrhage are uncommon, and lesions frequently involve the periventricular white matter or corpus callosum. Conversely, in immunocompromised patients, CNS lymphoma lesions are more likely to exhibit central necrosis, ring enhancement, and a propensity for intralesional microhemorrhage. These findings are atypical for CNS lymphoma in immunocompetent individuals and may resemble other conditions, such as cerebral abscesses or high-grade gliomas, requiring a different initial diagnostic approach.
Design/Methods:
We present the case of a previously healthy 35-year-old man who presented with a new-onset seizure and was found to have a left posterior temporal mass on MRI. HIV(Human Immunodeficiency Virus) testing was negative, and the patient had no underlying medical conditions that could compromise his immune system. The MRI revealed a ring-enhancing lesion with surrounding edema. Diffusion weighted images(DWI) and apparent diffusion coefficient(ADC) mapping demonstrated restricted diffusion confined in the enhancing rim. Gradient echo images showed intra-lesional hemorrhage. Initial differential diagnosis included high-grade glioma or abscess, and the patient underwent craniotomy and resection of the lesion with pathology confirming peripheral T cell lymphoma.
Conclusions:
This case highlights the diverse imaging features of CNS lymphoma, emphasizing the importance of considering lymphoma in the differential diagnosis of brain mass lesions. It also provides a rare example of peripheral T cell lymphoma presenting as a solitary brain lesion, along with descriptions of the patient's MRI imaging features.
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