Diagnostic Evaluation in Primary CNS Lymphoma

Neurologist. 2018 Mar;23(2):53-54. doi: 10.1097/NRL.0000000000000169.


The diagnosis of primary central nervous system lymphoma (PCNSL) may be fraught with difficulty. After initial imaging reveals enhancing intracranial mass lesions steroids are often initiated. This leads to a decreased diagnostic yield of tumor biopsies which may be associated with delay in treatment initiation. We review a case of PCNSL treated with a very brief steroid course. Initial nondiagnostic biopsy histopathology is juxtaposed against subsequent diagnostic pathology. Imaging before and after steroids is presented, as is imaging after tumor regrowth in a noncontiguous location. Elements in the clinical history and radiographic presentation which should raise suspicion for PCNSL are reviewed. Increased understanding of the potential pitfalls surrounding PCNSL diagnosis may limit their future occurrence.

Publication types

  • Case Reports

MeSH terms

  • Central Nervous System Neoplasms / diagnosis*
  • Central Nervous System Neoplasms / diagnostic imaging
  • Central Nervous System Neoplasms / drug therapy
  • Central Nervous System Neoplasms / pathology
  • Female
  • Humans
  • Lymphoma / diagnosis*
  • Lymphoma / diagnostic imaging
  • Lymphoma / drug therapy
  • Lymphoma / pathology
  • Magnetic Resonance Imaging
  • Middle Aged
  • Steroids / therapeutic use


  • Steroids