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PRIMARY T-CELL CNS LYMPHOMA MIMICKING VASCULITIS
  1. Bazo Raheem1,
  2. Hina Khan2,
  3. Neil Scolding3,
  4. Seth Love3,
  5. Safa Al-Sarraj1,
  6. Ranj Bhangoo1,
  7. Stephen Devereaux1,
  8. Nicholas Rooney3,
  9. Judith Sutak3,
  10. Nicholas Moran1
  1. 1 Kings College Hospital, London
  2. 2 East Kent Hospitals University
  3. 3 University of Bristol

Abstract

A 29 year old male presented with headache and no neurological signs. MRI brain strongly suggested an aggressive primary brain tumour in the right frontal lobe but histopathology revealed a pleomorphic lymphoid infiltrate, necrosis and vague granulomata and vasculitis was diagnosed. There was aggressive clinico-radiological progression despite two debunking surgeries, corticosteroids and cyclophosphamide.

On review the following were noted: areas of necrosis and focal diffuse lymphoid infiltrate showing perivascular cuffing; the presence of granuloma formation and vascular necrosis was less certain; overwhelming predominance of T-cells within the parenchyma; high T-cell mitotic activity and the mild nuclear atypia of the T-cells. PCR demonstrated no clonal immunoglobulin gene but showed a T-cell receptor gene rearrangements.

The diagnosis was revised to primary T-cell CNS Lymphoma. Arabinoside & methotrexate were administered.

Cerebral vasculitis may present with the imaging appearances of a malignancy. In the current case, a mass lesion was misdiagnosed as vasculitis due to atypical histopathology.

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