Primary Central Nervous System Lymphoma Presenting As Chronic Subdural Hematoma: Case Report and Review of the Literature.

Alexa Semonche,Robert M Starke,Pablo Gomez,John Paul G Kolcun,Roberto J Perez-Roman

doi:10.7759/cureus.7043

Abstract

Primary central nervous system lymphoma (PCNSL) rarely manifests in immunocompetent patients. In such cases, these lesions may mimic more common intracranial bleeding or tumors. We present the case of an elderly patient who presented with a presumed chronic subdural hematoma (SDH); upon surgical intervention, an occult mass was discovered with no evidence of associated hematoma. Biopsy and immunohistochemistry demonstrated PCNSL. Literature review identified six other cases of PCNSL in immunocompetent adults that were initially suspected to be SDH but were finally diagnosed with PCNSL. Our literature review highlights the rarity these cases and the importance of distinguishing intracranial bleeds from PCNSL, as the latter can be treated with chemoradiation with good clinical outcomes.

Highlights

Primary central nervous system lymphoma (PCNSL) is a rare variant of non-Hodgkin’s lymphoma (NHL), which is restricted to the brain, leptomeninges, cranial nerves, spinal cord, or intraocular compartment without involvement of other organ systems
We performed a literature review of all similar cases of PCNSL in immunocompetent adults with an initial diagnosis of an intracranial bleed based on radiographic findings, no finding of hematoma on surgical intervention, and final diagnosis of PCNSL based on histopathological findings
We present the rare case of a patient with long-standing PCNSL whose clinical course and imaging studies mimicked subdural hematoma (SDH) for several years

Summary

Introduction

Primary central nervous system lymphoma (PCNSL) is a rare variant of non-Hodgkin’s lymphoma (NHL), which is restricted to the brain, leptomeninges, cranial nerves, spinal cord, or intraocular compartment without involvement of other organ systems. Suggestive features of PCNSL on neuroimaging have been identified, they can mimic other pathologies that require different neurosurgical intervention. To illustrate this point, we present the case of an immunocompetent patient with presumed chronic subdural hematoma (SDH) which was . The angiogram demonstrated a slight arterial blush in the area of the hematoma, extensive imaging revealed no evidence of an obvious fistula. She was subsequently followed with serial imaging for more than two years, which demonstrated interval growth of the frontoparietal lesion from 8 to 15 mm for more than one year (Figure 1B). The patient did well, and was referred to medical and radiation oncology services to discuss chemoradiation therapy

Discussion

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Disclosures

Vardiman JW