Central Nervous System Lymphoma Initially Diagnosed as Tumefactive Multiple Sclerosis after Brain Biopsy

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Author(s)

    • Ohe Yasuko
    • Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
    • Hayashi Takeshi
    • Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan
    • Mishima Kazuhiko
    • Department of Neuro-Oncology, Saitama Medical University International Medical Center, Japan
    • Nishikawa Ryo
    • Department of Neuro-Oncology, Saitama Medical University International Medical Center, Japan
    • Matsuda Hiroshi
    • Department of Nuclear Medicine, Saitama Medical University International Medical Center, Japan
    • Uchino Akira
    • Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Japan
    • Tanahashi Norio
    • Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Japan

Abstract

A 72-year-old man was admitted with left homonymous hemianopsia and hemiparesis. Magnetic resonance imaging revealed a heterogeneously enhanced lesion in the right parietal lobe. A brain biopsy showed acute demyelination without malignancy, which led to a diagnosis of tumefactive multiple sclerosis (MS). The patient received corticosteroid therapy and experienced clinical and radiological improvement. Six months later, new lesions appeared, and a second biopsy revealed proliferation of dysplastic lymphocytes. This led to a revised diagnosis of primary central nervous system lymphoma (PCNSL). Because PCNSL mimics MS both clinically and radiologically, PCNSL is difficult to diagnose. Performing repeated brain biopsies may therefore be required when PCNSL is strongly suspected.<br>

Journal

  • Internal Medicine

    Internal Medicine 52(4), 483-488, 2013

    The Japanese Society of Internal Medicine

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