| Abstract [eng] |
Primary central nervous system lymphoma is a rare extranodal non-Hodgkin's lymphoma that has increasingly been diagnosed in immunocompetent individuals in recent decades. Its most common histological type is large B-cell lymphoma, and it involves only the brain, leptomeninges, and eyes, without systemic spread. Radiological studies play a crucial role in the diagnosis, staging, and follow-up of primary central nervous system lymphoma. Typically, it appears in computed tomography and magnetic resonance imaging as a solitary lesion accumulating contrast homogeneously in the supratentorial part of the brain. Advanced magnetic resonance sequences and methods not only allow for clear visualization of this tumor but also provide information about its histology and neurobiology. Diffusion, perfusion, functional, and spectroscopic imaging sequences offer unique additional information, enabling differentiation of brain structures, specifying the site of surgical intervention, and avoiding extensive surgical procedures that do not improve outcomes in lymphoma cases. This paper presents a clinical case of a patient who complained of balance disorder, fever of unknown origin, and diplopia. Computed tomography scans showed no pathology, and the patient was treated with glucocorticosteroids. As symptoms persisted, a magnetic resonance imaging study was conducted, revealing multiple T1-hypointense, T2/FLAIR-hyperintense foci with diffusion restriction and homogeneous contrast accumulation infratentorially and supratentorially. A biopsy confirmed diffuse large B-cell lymphoma, and after further evaluation and exclusion of systemic spread, a diagnosis of primary central nervous system lymphoma was established. Nonspecific clinical symptoms, computed tomography images without pathological changes, multiple foci visible on magnetic resonance imaging, and a positive histological response even after a course of glucocorticosteroids illustrate the challenges faced by clinicians in differentiating and diagnosing this rare disease. |
