[Intravascular lymphomatosis complicated with marked tumoral thrombosis of the brain venous system including dural sinuses. An autopsy case report with 5 months' follow-up and fatal outcome].

A 55-year-old man presented with mist, ptosis, and headache. Repeated imaging studies of the brain showed wandering lesions with small hemorrhage and/or infarct-like change. Leptomeningeal enhancement was noted. Angiography revealed filling defects in dural sinuses, particularly in the left cavernous sinus. Under the diagnosis of dural sinus thrombosis accompanied with rhinitis, antibiotics and anticlotting drugs were administered. Rhinitis was improved, however, the cavernous sinus lesion remained and grew. Autopsy revealed that large B-cell lymphoma occupied the cavernous sinuses and made a mass involving sella turcica, left sphenoid bone, hypophysis. No tumor mass in the brain or tumor dissemination in the leptomeninx was observed. Intima of the brain venous system, however, was widely involved by lymphoma cells admixed with thrombi, which produced occlusion of the leptomeningeal veins and dural sinuses. Various figures of recanalization were also present. It seems that a unique type of thrombosis, i.e. tumoral thrombosis of leptomeningeal veins and dural sinuses, caused by intravascular lymphoma resulted in fatal outcome with multiple brain lesions like hemorrhagic infarct. Recanalization may partly explain transient resolutions of these multiple lesions. It may be suggested that intravascular lymphomatosis can cause marked phlebothrombosis of the brain and can mimic dural sinus thrombosis.