Aki T, Nakamura T, Ichikizaki K, Iwata T, Toya S, Nakano S
No To Shinkei. 1982 Oct;34(10):965-71.
We have recently had a case of a patient with primary malignant lymphoma in whom the diagnosis was difficult and prednisolone was remarkably effective. The patient was a 59-year-old man. Mental signs developed rapidly over a period of approximately 1 month. On admission, he was confused; his orientation was disturbed and his impressibility and understanding were markedly decreased. CT scan on admission revealed a remarkable enhancement of a nodular high density area in front of the lateral ventricles, accompanied by a surrounding diffuse low density. Angiography failed to reveal a tumor stain. When prednisolone was administered to the patient, the high density area disappeared and neurological findings returned to normal. After that, left hemiparesis occurred twice and disappeared following the administration of prednisolone. After that, however, he was readmitted to our hospital because his left hemiparesis advanced rapidly. CT scan revealed a high density area in the right basal ganglia. It also decreased in several days after the administration of prednisolone. Malignant lymphoma was strongly suspected by operation. He was then readmitted to our department because of a gait disturbance, decrease in impressibility, and incontinence of urine about one year and a half after onset. CT scan revealed symmetrical ventricular dilatation. Although a shunt procedure was considered, gastrointestinal bleeding occurred, followed by rapid deterioration of his general condition and neurological signs. CT scan 2 days before death revealed a mass lesion in the left basal ganglia. Autopsy revealed that a gelatinous tumor, primarily in the left basal ganglia, was verified macroscopically, but that there was no specific tumor at any other site. Light microscopic examination revealed a diffuse infiltration of tumors cells around the blood vessels in the subependymal area of the lateral ventricle. Because tumor cells were not verified in any other organ, primary malignant lymphoma of the brain was considered. These results suggest that in the development of malignant lymphoma, once a mass lesion is formed, it is widely invasive especially along blood vessel walls. As far as we know, there have been no reports which describe a tumor decreasing or disappearing on CT scan following administration of steroid hormone alone.
