Recurrent Natural Killer Cell Lymphoma with Central Nervous System Metastasis Mimicking Cerebellar Infarction

Background Natural killer cell lymphoma is an uncommon hematologic malignancy, and central nervous system metastasis is rare. The classic magnetic resonance imaging appearance of lymphoma in the brain is T1 hypointense with strong homogeneous gadolinium enhancement, variable T2 signal, and restricte...

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Bibliographic Details
Published in:World neurosurgery 2015-12, Vol.84 (6), p.2074.e5-2074.e9
Main Authors: Li, Lai-fung, Leung, Gilberto Ka-kit, Ho, Ronnie Sin-lun, Lui, Wai-man
Format: Article
Language:English
Subjects:
Central Nervous System Neoplasms - secondary
Central Nervous System Neoplasms - surgery
Cerebellar Diseases - diagnosis
Cerebral Infarction - diagnosis
Contrast Media
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging
Epstein-Barr Virus Nuclear Antigens - analysis
Fatal Outcome
Gadolinium
Humans
Infarct
Killer Cells, Natural - pathology
Lymphoma
Lymphoma, Non-Hodgkin - pathology
Lymphoma, Non-Hodgkin - surgery
Male
Middle Aged
MRI
Neurosurgery
Neurosurgical Procedures - methods
Testicular Neoplasms - pathology
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Summary:Background Natural killer cell lymphoma is an uncommon hematologic malignancy, and central nervous system metastasis is rare. The classic magnetic resonance imaging appearance of lymphoma in the brain is T1 hypointense with strong homogeneous gadolinium enhancement, variable T2 signal, and restricted diffusion on diffusion-weighted images. Gadolinium enhancement is an important feature to differentiate lymphoma from infarction. Case Description We present the case of a middle-aged man who presented with recurrent natural killer cell lymphoma that metastasized to the cerebellum. Computed tomography and magnetic resonance imaging did not show a contrast-enhancing lesion; imaging features were more suggestive of cerebral infarction. The patient subsequently died, and postmortem examination confirmed natural killer cell lymphoma metastasis to the cerebellum. Conclusions Lymphoma can mimic cerebral infarction on computed tomography and magnetic resonance imaging. An imaging appearance of cerebral infarction in a patient with a history of lymphoma should raise suspicions of lymphoma metastasis.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2015.06.076