Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2024; 12(2): 374-382
Published online Jan 16, 2024. doi: 10.12998/wjcc.v12.i2.374
Absence of enhancement in a lesion does not preclude primary central nervous system T-cell lymphoma: A case report
Chan-Seop Kim, Chi-Hoon Choi, Kyung Sik Yi, Yook Kim, Jisun Lee, Chang Gok Woo, Young Hun Jeon
Chan-Seop Kim, Chi-Hoon Choi, Kyung Sik Yi, Yook Kim, Jisun Lee, Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Chang Gok Woo, Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Young Hun Jeon, Department of Radiology, Seoul National University Hosptial, Seoul 03080, South Korea
Author contributions: Kim CS, Choi CH, and Yi KS contributed to manuscript writing and editing and data collection; Kim CS contributed to data analysis; Kim CS, Choi CH, Yi KS, Kim Y, Lee J, Jeon YH and Woo CG contributed to conceptualization and supervision; All authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chi-Hoon Choi, MD, Professor, Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju-si 28644, Chungcheongbuk-do, South Korea. chihoonc@chungbuk.ac.kr
Received: September 12, 2023
Peer-review started: September 12, 2023
First decision: November 30, 2023
Revised: December 12, 2023
Accepted: December 27, 2023
Article in press: December 27, 2023
Published online: January 16, 2024
Abstract
BACKGROUND

Primary central nervous system lymphoma (PCNSL) is a non-Hodgkin lymphoma that originates in the central nervous system (CNS) and is exclusively limited to the CNS. Although most PCNSLs are diffuse large B-cell lymphomas, primary CNS T-cell lymphomas (PCNSTLs) are rare. PCNSTLs typically demonstrate some degree of enhancement on contrast-enhanced magnetic resonance imaging (MRI). To the best of our knowledge, non-enhancing PCNSTL has not been reported previously.

CASE SUMMARY

A 69-year-old male presented to the neurology department with complaints of mild cognitive impairment and gradual onset of left lower leg weakness over a span of two weeks. Initial MRI showed asymmetric T2-hyperintense lesions within the brain. No enhancement was observed on the contrast-enhanced T1 image. The initial diagnosis was neuro-Behçet’s disease. Despite high-dose steroid therapy, no alterations in the lesions were identified on initial MRI. The patient’s symptoms deteriorated further. An MRI performed one month after the initial scan revealed an increased lesion extent. Subsequently, brain biopsy confirmed the diagnosis of PCNSTL. The patient underwent definitive combined chemo-radiotherapy. However, the patient developed bacteremia and died of septic shock approximately three months after diagnosis.

CONCLUSION

The absence of enhancement in the lesion did not rule out PCNSTL. A biopsy approach is advisable for pathological confirmation.

Keywords: Central nervous system neoplasms, Non-Hodgkin Lymphoma, T-cell Lymphoma, Primary central nervous system lymphoma, Primary central nervous system T-cell lymphoma, Case report

Core Tip: The characteristic features of primary central nervous system T-cell lymphoma (PCNSTL) are not widely recognized owing to its low incidence rate. However, most malignant tumors demonstrate enhancement on gadolinium-enhanced magnetic resonance imaging (MRI). Consequently, a lesion without enhancement on gadolinium-enhanced MRI can easily be misinterpreted, potentially underestimating its malignant potential. Given the significant differences in the management of malignant and benign lesions, an accurate diagnosis is imperative for appropriate intervention. We present a case of PCNSTL without MRI enhancement. In instances of non-enhancing lesions with a clinical suspicion of malignancy, a more aggressive diagnostic approach should be adopted.