Tomita Yusuke, Iwamoto Naotaka, Hayashi Takaki, Takahashi Mikiko, Yamada Shoko Merrit
Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan.
Department of Radiology, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan.
Radiol Case Rep. 2023 Feb 4;18(4):1514-1517. doi: 10.1016/j.radcr.2023.01.008. eCollection 2023 Apr.
When using imaging to diagnose brain tumors, it is important to determine whether the tumor is intra- or extra-parenchymal. An 80-year-old man was found on magnetic resonance imaging to have an enhanced mass that appeared to be in the falx and a massive hematoma in the left frontal lobe; the provisional diagnosis was falx meningioma. However, the tumor and hematoma were found intraoperatively to be completely intraparenchymal. Additionally, the falx was intact and not adherent to brain tissue. Malignant lymphoma was diagnosed histologically on the basis of abnormal proliferation of atypical CD20-positive lymphocytes. Cerebral hemorrhage is an extremely rare presentation of primary central nervous system lymphoma. To the best of our knowledge, only 7 cases have been reported. All the reported cases had enhancement in the hematoma; however, in our case, there was definite enhancement outside the hematoma, making the correct diagnosis of lymphoma difficult.
在使用影像学诊断脑肿瘤时，确定肿瘤是脑实质内还是脑实质外很重要。一名80岁男性经磁共振成像检查发现有一个强化肿块，似乎位于大脑镰，左额叶还有一个巨大血肿；初步诊断为大脑镰脑膜瘤。然而，术中发现肿瘤和血肿完全位于脑实质内。此外，大脑镰完整，未与脑组织粘连。根据非典型CD20阳性淋巴细胞的异常增殖，组织学诊断为恶性淋巴瘤。脑出血是原发性中枢神经系统淋巴瘤极为罕见的表现。据我们所知，仅报道过7例。所有报道的病例血肿均有强化；然而，在我们的病例中，血肿外有明确强化，使得淋巴瘤的正确诊断变得困难。
