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A 45 year old woman who had always been in good health experienced abnormal temperature sensations in the right arm and leg for one year. When she subsequently started to complain of clumsiness of the right hand and difficulties in finding the right words, she was referred to a neurologist. A discrete expressive dysphasia and slight right sided pyramidal tract dysfunction were noticed. Brain MRI showed a large contrast enhancing sharply demarcated tumour with multiple cysts in the left parietal lobe (figure A). There was no surrounding oedema. The neurosurgeon completely extirpated a gelatinous tumour with a diameter of 7 cm. On pathological examination large eosinophilic islands of protein and perivascular cuffing of tumour cells were found (figure B; haematoxylin and eosin originally×25). The tumour proved to be a low grade lymphoplasmacytoid lymphoma (REAL classification) producing IgM light chain (lambda) immunoglobulins (figure B, inset; haemotoxylin and eosin originally×175). Postoperative MRI showed no residual tumour. No lymphoma was found in the bone marrow, thorax, and abdomen. Moreover, laboratory values were normal and no paraproteins were found in serum or urine. She was treated with whole brain radiotherapy.
