Invasive and Multiple Lesions of Primary Central Nervous System Lymphoma: A Case Report

Abstract Background: Primary central nervous system lymphoma (PCNSL) is rare, malignant, non-Hodgkin lymphoma in the central nervous system. Solitary lesions occurred in the majority of cases. Invasive and multiple lesions were rarely reported. As clinical presentations and neuroimage are variable, early diagnosis is challenging. Case presentation: The patient was a 61-year-old male with normal immunity who firstly experienced drowsiness and dizziness. Cranial magnetic resonance imaging(MRI) revealed invasive and multiple lesions of cerebellar hemisphere, right pons, bilateral thalamus and right frontal lobe with slightly long T1 and T2 signal. Contrast-enhanced MRI demonstrated enhanced signal shadows in the cerebellar hemisphere rather than other areas. Magnetic resonance spectroscopy (MRS) showed lactate (Lac) peak increases and N-acetyl-aspartate (NAA) peak decreases moderately. Histopathological examination revealed infiltrative growth of abnormal lymphoid cells. The immunohistochemical analysis detected the result of CD10(-), Bcl-6(+), MUM-1(+), accessing the diagnosis of diffuse large B-cell lymphoma (Non-GCB).Conclusions: PCNSL with invasive lesions distributed in supratentorial and infratentorial sites were rarely reported, resulting in the delayed diagnosis in this case. This case not only expands the clinical spectrum but also extends the distribution of PCNSL.