Primary t-cell cns lymphoma mimicking vasculitis

A 29 year old male presented with headache and no neurological signs. MRI brain strongly suggested an aggressive primary brain tumour in the right frontal lobe but histopathology revealed a pleomorphic lymphoid infiltrate, necrosis and vague granulomata and vasculitis was diagnosed. There was aggressive clinico-radiological progression despite two debunking surgeries, corticosteroids and cyclophosphamide. On review the following were noted: areas of necrosis and focal diffuse lymphoid infiltrate showing perivascular cuffing; the presence of granuloma formation and vascular necrosis was less certain; overwhelming predominance of T-cells within the parenchyma; high T-cell mitotic activity and the mild nuclear atypia of the T-cells. PCR demonstrated no clonal immunoglobulin gene but showed a T-cell receptor gene rearrangements. The diagnosis was revised to primary T-cell CNS Lymphoma. Arabinoside & methotrexate were administered. Cerebral vasculitis may present with the imaging appearances of a malignancy. In the current case, a mass lesion was misdiagnosed as vasculitis due to atypical histopathology.
Source: Journal of Neurology, Neurosurgery and Psychiatry - Category: Neurosurgery Authors: Tags: Genetics, Immunology (including allergy), Headache (including migraine), Pain (neurology), Drugs: musculoskeletal and joint diseases, Vascularitis, Surgical oncology ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research