Unusual presentation of secondary CNS lymphoma with punctate intralesional and intraventricular hemorrhage

Primary and secondary central nervous system lymphomas are infrequently encountered entities that present nonspecifically for which imaging plays a critical role in the diagnostic process. The conventional wisdom is that the presence of intralesional hemorrhage in an immunocompetent patient strongly...

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Main Authors: Daniel De-Liang Loh, Ira Sun, Shiong Wen Low, Pin Lin Kei
Format: Article
Language:English
Published: Elsevier 2025-04-01
Series:Radiology Case Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S1930043325000378
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author Daniel De-Liang Loh
Ira Sun
Shiong Wen Low
Pin Lin Kei
author_facet Daniel De-Liang Loh
Ira Sun
Shiong Wen Low
Pin Lin Kei
author_sort Daniel De-Liang Loh
collection DOAJ
description Primary and secondary central nervous system lymphomas are infrequently encountered entities that present nonspecifically for which imaging plays a critical role in the diagnostic process. The conventional wisdom is that the presence of intralesional hemorrhage in an immunocompetent patient strongly counts against the diagnosis of lymphoma; however more recent evidence suggests that the distinction is more nuanced. Especially for PCNSL, there is increasing recognition that some degree of hemorrhage occurs more frequently than previously thought, and there are a number of case reports describing various types of hemorrhagic lesions that were histologically confirmed to be lymphoma. Hemorrhage in SCNSL is much rarer with only 3 cases described to date. We describe an unusual case of SCNSL with a pattern and progression of hemorrhage distinct from the prior descriptions. Awareness of the range of possible appearances of atypical presentations of CNS lymphoma is important to ensure that it is not prematurely excluded from the differential diagnosis which can delay appropriate treatment. Although rare, intralesion hemorrhage in itself should not preclude the diagnosis of lymphoma particularly when the other imaging features are congruent.
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spelling doaj-art-1d83f510bbd34c6eb1a5ecef9dbe26f42025-02-02T05:27:02ZengElsevierRadiology Case Reports1930-04332025-04-0120421442147Unusual presentation of secondary CNS lymphoma with punctate intralesional and intraventricular hemorrhageDaniel De-Liang Loh0Ira Sun1Shiong Wen Low2Pin Lin Kei3Department of Diagnostic Radiology, National University Hospital, Singapore, SingaporeDepartment of Neurosurgery, Ng Teng Fong General Hospital, Singapore, SingaporeDepartment of Neurosurgery, Ng Teng Fong General Hospital, Singapore, SingaporeDepartment of Diagnostic Radiology, Ng Teng Fong General Hospital, Singapore, Singapore; Corresponding author.Primary and secondary central nervous system lymphomas are infrequently encountered entities that present nonspecifically for which imaging plays a critical role in the diagnostic process. The conventional wisdom is that the presence of intralesional hemorrhage in an immunocompetent patient strongly counts against the diagnosis of lymphoma; however more recent evidence suggests that the distinction is more nuanced. Especially for PCNSL, there is increasing recognition that some degree of hemorrhage occurs more frequently than previously thought, and there are a number of case reports describing various types of hemorrhagic lesions that were histologically confirmed to be lymphoma. Hemorrhage in SCNSL is much rarer with only 3 cases described to date. We describe an unusual case of SCNSL with a pattern and progression of hemorrhage distinct from the prior descriptions. Awareness of the range of possible appearances of atypical presentations of CNS lymphoma is important to ensure that it is not prematurely excluded from the differential diagnosis which can delay appropriate treatment. Although rare, intralesion hemorrhage in itself should not preclude the diagnosis of lymphoma particularly when the other imaging features are congruent.http://www.sciencedirect.com/science/article/pii/S1930043325000378Secondary CNS lymphomaIntratumoural hemorrhage
spellingShingle Daniel De-Liang Loh
Ira Sun
Shiong Wen Low
Pin Lin Kei
Unusual presentation of secondary CNS lymphoma with punctate intralesional and intraventricular hemorrhage
Radiology Case Reports
Secondary CNS lymphoma
Intratumoural hemorrhage
title Unusual presentation of secondary CNS lymphoma with punctate intralesional and intraventricular hemorrhage
title_full Unusual presentation of secondary CNS lymphoma with punctate intralesional and intraventricular hemorrhage
title_fullStr Unusual presentation of secondary CNS lymphoma with punctate intralesional and intraventricular hemorrhage
title_full_unstemmed Unusual presentation of secondary CNS lymphoma with punctate intralesional and intraventricular hemorrhage
title_short Unusual presentation of secondary CNS lymphoma with punctate intralesional and intraventricular hemorrhage
title_sort unusual presentation of secondary cns lymphoma with punctate intralesional and intraventricular hemorrhage
topic Secondary CNS lymphoma
Intratumoural hemorrhage
url http://www.sciencedirect.com/science/article/pii/S1930043325000378
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