颅内淋巴瘤影像诊断.pptVIP

CASE DISCUSSION WANG LIJUN 2008-7-14 Case 1: PLAIN MRI LYMPHOMA Primary central nervous system lymphoma (PCNSL) is a rare form of lymphatic cancer arising in the brain, eye, nerves, spinal fluid surrounding the brain and spinal cord, and the covering of the brain, called dura Secondary: metastases to the nervous system in lymphoma affecting other organs PCNSL: Epidemiology Once rare (~1%), now becoming increasingly more common Incidence has risen dramatically in past few decades, as PCNSL now accounts for 4-7% (16%) of all newly diagnosed primary brain tumors Incidence has risen in the immunocompromised and also immunocompetent population PCNSL: Epidemiology Immunocompromised Congenital causes of immunodeficiency 1.Wiskott-Aldrich syndrome 2.IgA deficiency 3.X-linked lymphoproliferative syndrome acquired causes 1. HIV infection and AIDS 2.immunosuppressive regimen after organ transplantation PCNSL: Epidemiology Median age of onset 55 years in immunocompetent, incidence rises with age Greatest rise has occurred among the elderly Male is more commonly seen compare to female (2:1) Diagnosis History Focal neurologic deficit (i.e. hemiparesis, aphasia) present in 50% of all patients with PCNSL Altered mental status (memory loss, confusion, etc.) found in ~33% - may be insidious onset Headache, nausea (from increased ICP) in ~33% May present with new-onset seizure in 10% Blurred vision if ocular lymphoma is present Radiologic imaging Head CT detects most lesions (~90%) Brain MRI may detect lesions missed on CT Diagnosis Primary CNS lymphoma may arise from different parts of the brain deep hemispheric periventricular white matter being the most common corpus callosum, cerebellum, orbits, and cranial nerves may also harbor the tumor Histology: intermediate- to high-grade extranodal non-Hodgkins lymphoma of B-cell origin Radiologic ImagingTypical Appearance in Immunocompetent Patients Usually solitary, non-hemorrhagic lesion in deep whi