Abstract
BackgroundPrimary central nervous system lymphoma (PCNSL) is a rare, aggressive brain neoplasm that accounts for roughly 2-6% of primary brain tumors. In contrast, glioblastoma (GBM) is the most frequent and severe glioma subtype, accounting for approximately 50% of diffuse gliomas. The aim of the present study was to evaluate morphological MRI characteristics in histologically-proven PCNSL and GBM at the time of their initial presentation.MethodsWe retrospectively evaluated standard diagnostic MRI examinations in 54 immunocompetent patients (26 female, 28 male; age 62.6 ± 11.5 years) with histologically-proven PCNSL and 54 GBM subjects (21 female, 33 male; age 59 ± 14 years).ResultsSeveral significant differences between both infiltrative brain tumors were found. PCNSL lesions enhanced homogenously in 64.8% of cases, while nonhomogeneous enhancement was observed in 98.1% of GBM cases. Necrosis was present in 88.9% of GBM lesions and only 5.6% of PCNSL lesions. PCNSL presented as multiple lesions in 51.9% cases and in 35.2% of GBM cases; however, diffuse infiltrative type of brain involvement was observed only in PCNSL (24.1%). Optic pathways were infiltrated more commonly in PCNSL than in GBM (42.6% vs. 5.6%, respectively, p <0.001). Other cranial nerves were affected in 5.6% of PCNSL, and in none of GBM. Signs of bleeding were rare in PCNSL (5.6%) and common in GBM (44.4%); p < 0.001. Both supratentorial and infratentorial localization was present only in PCNSL (27.7%). Involvement of the basal ganglia was more common in PCNSL (55.6%) than in GBM (18.5%); (p < 0.001). Cerebral cortex was affected significantly more often in GBM (83.3%) than in PCNSL (51.9%); mostly by both enhancing and non-enhancing infiltration.ConclusionRoutine morphological MRI is capable of differentiating between GBM and PCNSL lesions in many cases at time of initial presentation. A solitary infiltrative supratentorial lesion with nonhomogeneous enhancement and necrosis was typical for GBM. PCNSL presented with multiple lesions that enhanced homogenously or as diffuse infiltrative type of brain involvement, often with basal ganglia and optic pathways affection.
Highlights
Primary central nervous system lymphoma (PCNSL) is a rare, aggressive brain neoplasm that accounts for roughly 2-6% of primary brain tumors
diffuse large B-cell lymphoma (DLBCL) was histologically proven in all patients, and systemic lymphoma was excluded by bone marrow biopsy, whole-body computed tomography (CT) or whole-body positron emission tomography/CT
Other cranial nerves were affected in 5.6% of PCNSL cases; in one case (1.9%) the optic and trigeminal nerve was affected, and in one case (1.9%) the optic nerves and both auditory and facial nerves were involved and in one case (1.9%) solitary infiltration of the auditory nerve was present without other brain lesions (Fig. 4a, b)
Summary
Primary central nervous system lymphoma (PCNSL) is a rare, aggressive brain neoplasm that accounts for roughly 2-6% of primary brain tumors. Glioblastoma (GBM) is the most frequent and severe glioma subtype, accounting for approximately 50% of diffuse gliomas. Glioblastoma (GBM) and primary central nervous lymphoma (PCNSL) differ in many respects, it is often reported that morphological differentiation between them by MRI is difficult [1]. GBM is the most frequent and severe glioma subtype and accounts for about approximately 50% of diffuse gliomas. It is characterized by infiltration beyond the enhancing margin and with rapid growth [10, 11]. The primary treatment for GBM is surgical resection followed by radiation therapy and chemotherapy [12]
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