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AJNR - American Journal of Neuroradiology

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Radiologic Morphology of Low-Grade Primary Central Nervous System Lymphoma in Immunocompetent Patients

Kristoph Jahnke^a, Andreas Schilling^b, Jens Heidenreich^b, Harald Stein^c, Mario Brock^d, Eckhard Thiel^a and Agnieszka Korfel^a

^a Department of Hematology, Oncology and Transfusion Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
^b Department of Radiology, Division of Neuroradiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
^c Department of Pathology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
^d Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

View larger version (119K): [in a new window]   FIG 1. Histologic preparations of low-grade PCNSLs (patient 9; lymphoplasmacellular lymphoma), opposed to high-grade PCNSLs. A, Infiltrates of small, mature lymphocytes surrounded by amorphous substance (immunohistologic demonstration of light-chain deposits) and absence of blastic, immature cells (hematoxylin and eosin; original magnification x400). The lymphocytes are positive for the B-cell antigen CD20 and show a predominant expression of the immunoglobulin light chain lambda, indicating monoclonality (not shown). B, Typical appearance of high-grade PCNSL, composed of immature blasts with large and partly bean-shaped nuclei and prominent nucleoli (hematoxylin and eosin; original magnification x400). C, Lymphoma cells of low-grade PCNSL demonstrate a low growth fraction of only 2% (Ki-67 antibody; original magnification x200). D, High-grade PCNSL with a typical high growth fraction of 95% (MIB-1 antibody; original magnification x400). Note.—Reproduced from K. Jahnke et al, Br J Haematol 2005;128:616–624 (© British Society for Haematology).

View larger version (71K): [in a new window]   FIG 2. Case 3, 60-year-old man with low-grade B-cell lymphoma (no further histologic specification). A, T2-weighted turbo spin-echo sequence. B, Precontrast T1-weighted spin-echo sequence. C, Postcontrast T1-weighted spin-echo sequence. On the precontrast T1-weighted image, the lymphoma (arrows) already demonstrates mild hyperintense spots, and only minor contrast enhancement is noted on the postcontrast T1-weighted sequence. In addition, on T2-weighted imaging, periventricular and basal ganglia edema is noted. Note.—Reproduced from K. Jahnke et al, Br J Haematol 2005;128:616–624 (© British Society for Haematology).

View larger version (66K): [in a new window]   FIG 3. Case 9, 19-year-old man with low-grade B-cell lymphoma (subtype lymphoplasmacellular lymphoma). A, Extensive hyperintense appearance of the lesion adjacent to the posterior aspect of the right lateral ventricle in FLAIR sequence. B and C, Surprisingly low contrast enhancement on T1-weighted imaging. Moderate edema is noted on T2-weighted imaging (not shown).

View larger version (152K): [in a new window]   FIG 4. Case 1, 58-year-old man with an intramedullary low-grade T-cell lymphoma. A, T2-weighted turbo spin-echo sequence. B, Postcontrast T1-weighted spin-echo sequence with 2 lymphoma manifestations, situated at the level of the cervicothoracic junction and the thoracic vertebrae 4 and 5 (arrows). Both lesions demonstrate pronounced local edema. The upper lesion shows a marked, homogeneous contrast enhancement, whereas the lower lesion demonstrates only mild contrast enhancement. This patient did not have cerebral lymphoma manifestations. Note.—Reproduced from K. Jahnke et al, Br J Haematol 2005;128:616–624 (© British Society for Haematology).

View larger version (137K): [in a new window]   FIG 5. Case 2, 58-year-old man with T-cell lymphoma. A right periventricular lesion with strong and homogeneous contrast enhancement is noted on T1-weighted postcontrast spin-echo sequence. Despite radiologic features typical of high-grade PCNSLs, histopathologic investigation revealed a low-grade PCNSL with a growth fraction of 1%.

View larger version (112K): [in a new window]   FIG 6. Case 10, 45-year-old man with low-grade B-cell lymphoma (no further histologic specification; arrows) with bifrontal hyperintense periventricular white matter lesions on A, T2-weighted, and B, FLAIR images. C, The lesions are not visible on T1-weighted precontrast imaging. D, No contrast enhancement is noted on the T1-weighted postcontrast section. E, This T2-weighted image additionally demonstrates a small area of hyperintensity located in the head of the corpus callosum.