Primary malignant lymphoma of the brain

Primary malignant lymphoma of the brain is a disease of unknown etiology, which is increasing in incidence and has an unfavorable prognosis. Despite the lack of specific changes on CT or MRI in most cases, these procedures may typically facilitate the diagnosis: a focal-enhancing mass with subependymal spread on CT or MRI and hyperattenuation on nonenhanced CT are the most reliable features in the diagnosis of primary malignant lymphoma of the brain. Peritumoral edema and mass effect are usually not prominent features. On unenhanced CT scans they usually appear homogeneously isodense to mildly hyperdense relative to the gray matter. On MRI these tumors are slightly hypointense on T1-weighted images and slightly hyperintense on PD- and T2-weighted images relative to the gray matter. On CT and MRI enhancement is usually homogeneous. Contrast-enhanced MRI, with its multiplanar capability, lack of bone-induced artifacts, and high-contrast resolution, is likely to reveal subependymal spread and meningeal involvement that have escaped detection by CT. Because there are no specific features on CT or MRI in most cases, patients who are suspected of having primary malignant lymphoma of the brain should immediately undergo biopsy and, if the diagnosis is confirmed, whole-brain radiation therapy. With early diagnosis and treatment, these patients benefit from radiation therapy.