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具有非典型T2高信号和坏死、酷似多形性胶质母细胞瘤的中枢神经系统非霍奇金淋巴瘤：一个影像学谜团。

CNS Non-Hodgkin's Lymphoma With Atypical T2 Hyperintensity and Necrosis Mimicking Glioblastoma Multiforme: A Radiological Enigma.

作者信息

Haroon Ahmed Mohammed, Mohammed Abdul Mukarram, Nadeem Ayman, Yaratapally Nigama, Abid Mirza, Mohammad Abdul Malik, Ali Mohammed Abdul Muhaimin, Athmakuri Krishna S, Mohammed Omer Farooq, Bhadra Tushar

机构信息

Radiodiagnosis, Gandhi Medical College, Hyderabad, IND.

General Surgery, Osmania Medical College, Hyderabad, IND.

出版信息

Cureus. 2025 Aug 4;17(8):e89353. doi: 10.7759/cureus.89353. eCollection 2025 Aug.

DOI:10.7759/cureus.89353
PMID:40909039
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12407577/
Abstract

A 45-year-old female presented with a 15-day history of headache and blurred vision. MRI of the brain revealed multiple irregular, T2-hyperintense lesions with significant surrounding edema, central necrosis, peripheral rim enhancement, and corpus callosum involvement resulting in a "butterfly" appearance. These imaging features led to an initial radiological impression of multifocal glioblastoma multiforme. Subsequent histopathological examination of a brain biopsy provided a definitive diagnosis of CNS non-Hodgkin's lymphoma (CNS-NHL). The biopsy showed dense perivascular cuffing by atypical large lymphocytes with notable mitoses and adjacent edema. This report illustrates an imaging presentation of CNS lymphoma that differed from common patterns, particularly the prominent T2 hyperintensity within the enhancing rim and central necrosis, posing a diagnostic challenge resolved using histopathological analysis. The findings emphasize the importance of tissue diagnosis in cases with complex neuroimaging presentations suggestive of high-grade glioma.

摘要

一名45岁女性，有15天的头痛和视力模糊病史。脑部MRI显示多个不规则的T2高信号病变，周围有明显水肿、中央坏死、周边环形强化，累及胼胝体，呈“蝴蝶”状。这些影像学特征最初使放射科诊断为多形性胶质母细胞瘤。随后对脑活检进行的组织病理学检查确诊为中枢神经系统非霍奇金淋巴瘤（CNS-NHL）。活检显示非典型大淋巴细胞围绕血管密集袖套状浸润，有明显的核分裂象及相邻水肿。本报告展示了中枢神经系统淋巴瘤一种不同于常见模式的影像学表现，特别是强化边缘内显著的T2高信号和中央坏死，这给诊断带来了挑战，通过组织病理学分析得以解决。这些发现强调了在神经影像学表现复杂提示高级别胶质瘤的病例中进行组织诊断的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/6e6719eb0763/cureus-0017-00000089353-i13.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/78de4e2b412d/cureus-0017-00000089353-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/806de6f8bec1/cureus-0017-00000089353-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/fe0af281ca65/cureus-0017-00000089353-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/b988340b0b54/cureus-0017-00000089353-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/f024b709d4ee/cureus-0017-00000089353-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/d27d754b31c4/cureus-0017-00000089353-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/742cd5b20cc1/cureus-0017-00000089353-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/1084aa78208d/cureus-0017-00000089353-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/dbd93a2f14e6/cureus-0017-00000089353-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/cdf046a36510/cureus-0017-00000089353-i10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/60bb7f9ab5b4/cureus-0017-00000089353-i11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/d14eaa3fd415/cureus-0017-00000089353-i12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/6e6719eb0763/cureus-0017-00000089353-i13.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/78de4e2b412d/cureus-0017-00000089353-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/806de6f8bec1/cureus-0017-00000089353-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/fe0af281ca65/cureus-0017-00000089353-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/b988340b0b54/cureus-0017-00000089353-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/f024b709d4ee/cureus-0017-00000089353-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/d27d754b31c4/cureus-0017-00000089353-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/742cd5b20cc1/cureus-0017-00000089353-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/1084aa78208d/cureus-0017-00000089353-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/dbd93a2f14e6/cureus-0017-00000089353-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/cdf046a36510/cureus-0017-00000089353-i10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/60bb7f9ab5b4/cureus-0017-00000089353-i11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/d14eaa3fd415/cureus-0017-00000089353-i12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8edc/12407577/6e6719eb0763/cureus-0017-00000089353-i13.jpg

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