Primer santral sinir sistemi lenfoması

Özet

Primer santral sinir sistemi lenfoması (PCNSL), beyin parankimi, göz, leptomeninks veya omurilikte ortaya çıkabilen agresif bir lenfomadır; bağışıklığı normal kişilerde de görülür. Kontrastsız BT’de derin veya periventriküler hiperdens kitle PCNSL’yi düşündürebilir; ancak tanısal inceleme olarak kontrastlı MRG tercih edilir. Kontrastlı MRG tanısal incelemede tercih edilir; BT’deki görünüm lenfomayı gliom, metastaz veya enfeksiyondan tek başına ayıramaz. PCNSL’de kitle infiltrasyonu ve kompresyon nörolojik belirtilere yol açabilir; ventriküler yerleşimli lezyonlarda obstrüksiyon ve hidrosefali gelişebilir.

Faz ve pencere

Kontrastsız tanısal

Periventriküler beyaz cevher, korpus kallozum veya bazal gangliyonda kortekse göre izo-hiperdens solid kitle görülebilir; çevresinde değişen ölçüde hipodens ödem bulunabilir. Kontrastsız BT kontrastlanma örüntüsünü göstermez ve normal BT PCNSL’yi dışlamaz.

Önerilen pencereler: Beyin (G 80 / M 40).

BT bulguları

• Periventriküler odak — lateral ventrikül duvarına bitişik beyaz cevher veya subependimal yüzey boyunca yerleşir.
• Derin gri cevher tutulumu — bazal gangliyon veya talamusta kitle ve çevresel ödem oluşturabilir.
• Korpus kallozum uzanımı — orta hatta geçerek iki hemisfer derin beyaz cevherini tutabilir.
• Kontrastsız BT’de göreli hiperdensite — hücresel yoğunlukla ilişkili olabilir; bulgu tanıya özgü değildir.
• Ödem ve kitle etkisi — değişen derecelerde eşlik edebilir; tek başına miktarı ayırıcı tanı koydurmaz.
• Kontrastlı incelemede belirgin solid kontrastlanma — sıklıkla homojen örüntüdedir; bu özellik kontrastsız görüntüden çıkarılamaz.
• Nekroz, kanama veya kalsifikasyon — bağışıklığı normal hastada tipik değildir; varlığı atipik sunum veya alternatif tanıyı gündeme getirir.

Normalde

Periventriküler alanı, korpus kallozumu ve bazal gangliyonları lezyon açısından incele; PCNSL bu bölgelerde sık yerleşebilir.

Ayırıcı tanı

Glioblastom

PCNSL’ye göre genellikle daha yüksek rCBV, heterojen yapı ve nekroz ile karakterize iken; PCNSL sıklıkla homojen kontrastlanma, düşük ADC ve periventriküler yerleşim gösterir.

Beyin metastazı PCNSL’nin ayırıcı tanıları arasındadır; klinik ve görüntüleme bulguları ayırıcı tanıyı daraltmaya yardımcı olabilir.

Nörotoksoplazmoz

bağışıklığı baskılanmış hastada çoğunlukla çoklu halka biçimli lezyonlar ve bazal gangliyon tutulumu görülür; lezyonlarda eksantrik hedef işareti toksoplazmozu destekler.

Beyin apsesi

kaynaklar apseyi yalnızca ayırıcı tanı olarak listeler, apsenin halka biçimli kontrastlanma veya difüzyon kısıtlanması gibi ayırıcı özelliklerini bu metinlerde detaylandırmaz.

Akut enfarkt ve intravasküler lenfoma

kaynaklar intravasküler lenfomanın kortikal-subkortikal enfarkt benzeri lezyonlar oluşturduğunu belirtir; akut enfarktın arteriyel dağılım özelliği kaynaklarda yer almamaktadır.

Tuzaklar

• Kontrastsız BT'de görülen hiperdensite yüksek hücrellikle ilişkilidir; tanının kesinleşmesi için kontrastlı MRG ve histolojik doğrulama gereklidir.
• Bağışıklığı baskılanmış hastadaki çoklu halka biçimli odakları tipik PCNSL sayma: toksoplazmoz ve başka enfeksiyonlar güçlü taklitçilerdir.
• Kontrastsız BT’yi normal bulup lenfomayı dışlama: küçük veya izodens lezyonlar görünmeyebilir; klinik şüphede MRG gerekir.
• Tümöre bağlı ödemi kitle sınırı olarak kabul etme: PCNSL lezyonlarına değişen derecelerde vazojenik ödem eşlik edebilir.

Kendini dene

1. Derin periventriküler alanda kortekse göre hiperdens solid kitle görülüyor. Hangi tanı özellikle akla gelmelidir?

   • Primer SSS lenfoması
   • Menenjiyom
   • Beyin apsesi
   • Ensefalomalazi
   Cevabı göster

   Primer SSS lenfoması. Periventriküler yerleşim ve kontrastsız BT'de hiperdensite PCNSL'yi düşündürür; kesin tanı için stereotaktik biyopsi veya CSF analizleri gereklidir. Menenjiyom ekstraaksiyel, apse sıklıkla halka biçimli, ensefalomalazi ise hacim kayıplı parankim değişikliğidir.

2. Bağışıklığı baskılanmış hastada çoklu halka biçimli bazal gangliyon lezyonları var. En önemli ayırıcı tanı hangisidir?

   • Nörotoksoplazmoz
   • Menenjiyom
   • Düşük dereceli gliom
   • Kavernöz malformasyon
   Cevabı göster

   Nörotoksoplazmoz. Bağışıklığı baskılanmış kişide çoklu halka biçimli bazal gangliyon odakları nörotoksoplazmozu güçlü biçimde düşündürür. Menenjiyom ekstraaksiyel kitle yapar; diffüz gliom ve kavernom bu çoklu enfeksiyöz örüntüyü açıklamaz.

İlgili konular

• Glioblastom ve yüksek dereceli gliom
• Beyin metastazı
• Serebral toksoplazmoz

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 11 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. Primary central nervous system lymphoma in the molecular era: genomic drivers, liquid biopsy, and targeted therapeutic strategiespmc.ncbi.nlm.nih.gov
2. Primary central nervous system lymphoma—current standards and recent developmentspmc.ncbi.nlm.nih.gov
3. The Landscape of Primary Central Nervous System Lymphoma (PCNSL): Clinicopathologic and Genomic Characteristics and Therapeutic Perspectivespmc.ncbi.nlm.nih.gov
4. Advances in molecular pathobiology of PCNSL – towards clinical implementation of novel diagnostics and therapeuticspmc.ncbi.nlm.nih.gov
5. Diagnostic imaging and emerging image-guided neurointervention in brain tumors: a narrative reviewpmc.ncbi.nlm.nih.gov
6. Primary central nervous system lymphoma: Imaging features and differential diagnosis.pubmed.ncbi.nlm.nih.gov
7. Approach to an Intracranial Mass in Patients With HIV.pubmed.ncbi.nlm.nih.gov
8. [Malignant Lymphoma of the Brain, and Dementia].pubmed.ncbi.nlm.nih.gov
9. Diagnostic Performance of Pretreatment 18F-Fluorodeoxyglucose Positron Emission Tomography With or Without Computed Tomography in Patients With Primary Central Nervous System Lymphoma: Updated Systematic Review and Diagnostic Test Accuracy Meta-analyses.pubmed.ncbi.nlm.nih.gov
10. Consensus recommendations for MRI and PET imaging of primary central nervous system lymphoma: guideline statement from the International Primary CNS Lymphoma Collaborative Group (IPCG).pubmed.ncbi.nlm.nih.gov
11. Primary CNS lymphoma in HIV infection.pubmed.ncbi.nlm.nih.gov
12. Primary central nervous system lymphoma in immunocompetent patients: a retrospective review of MRI features.pubmed.ncbi.nlm.nih.gov
13. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus.pubmed.ncbi.nlm.nih.gov
14. Neuroimaging in Central Nervous System Lymphoma.pubmed.ncbi.nlm.nih.gov
15. Primary CNS Lymphomas: Challenges in Diagnosis and Monitoring.pubmed.ncbi.nlm.nih.gov
16. PET imaging for brain tumor diagnostics.pubmed.ncbi.nlm.nih.gov
17. Advances in Primary Central Nervous System Lymphoma.pubmed.ncbi.nlm.nih.gov
18. Extranodal Lymphoma of the Central Nervous System and Spine.pubmed.ncbi.nlm.nih.gov
19. Delivery of chemotherapeutics across the blood-brain barrier: challenges and advances.pubmed.ncbi.nlm.nih.gov
20. Primary central nervous system lymphoma in the molecular era: genomic drivers, liquid biopsy, and targeted therapeutic strategies.pubmed.ncbi.nlm.nih.gov
21. [Toxoplasmosis].pubmed.ncbi.nlm.nih.gov
22. Spectrum of Neuroimaging Findings in CNS Lymphoproliferative Disorders.pubmed.ncbi.nlm.nih.gov
23. Delayed Uptake on ¹²³I-IMP SPECT as a Diagnostic Clue in Cranial Vault Lymphoma in a 25-Year-Old Man: A Case Report.pubmed.ncbi.nlm.nih.gov
24. Whole-body magnetic resonance imaging vs. positron emission tomography-computed tomography in pediatric oncology: enhancing diagnostic precision for solid tumors.pubmed.ncbi.nlm.nih.gov
25. CXCR4-targeted PET/CT with [¹⁸F]AlF-NOTA-QHY-04 in primary central nervous system lymphoma: a prospective comparison with MRI and [¹⁸F]FDG PET/CT.pubmed.ncbi.nlm.nih.gov
26. Diagnostic imaging and emerging image-guided neurointervention in brain tumors: a narrative review.pubmed.ncbi.nlm.nih.gov
27. Imaging Features of Pediatric Primary Orbital Lymphomas: A Rare Case With Histopathological Correlation and Systematic Literature Review.pubmed.ncbi.nlm.nih.gov
28. Primary central nervous system lymphoma of the third ventricle: Diagnostic pitfalls, the "Ghost Tumor" phenomenon, and steroid-induced complications.pubmed.ncbi.nlm.nih.gov
29. Case Report: Suspected low-pressure hydrocephalus following surgical treatment of traumatic brain injury in a patient with subsequently diagnosed glioblastoma.pubmed.ncbi.nlm.nih.gov
30. Case Report: Rare presentations of glioblastoma: three multifocal and one cerebellar cases highlighting the value of shared clinical experience.pubmed.ncbi.nlm.nih.gov
31. Predictors for the Differentiation between Glioblastoma, Primary Central Nervous System Lymphoma, and Metastasis in Patients with a Solitary Enhancing Intracranial Mass.pubmed.ncbi.nlm.nih.gov
32. Electron Density and Effective Atomic Number as Quantitative Biomarkers for Differentiating Malignant Brain Tumors: An Exploratory Study with Machine Learning.pubmed.ncbi.nlm.nih.gov
33. Multiple myeloma presenting as dural plasmacytoma.pubmed.ncbi.nlm.nih.gov
34. Magnetic resonance imaging of the orbit, Part 2: Characterization of orbital pathologies.pubmed.ncbi.nlm.nih.gov
35. Magnetic resonance imaging of primary central nervous system neoplasms of dogs and cats: Basic concepts for diagnostic pathologists.pubmed.ncbi.nlm.nih.gov
36. Lymphoma Related to the Ventricular System: A Rare Case Report and Systematic Review of Intraventricular Lymphomas.pubmed.ncbi.nlm.nih.gov
37. Left Pulvinar Thalamic Tumor with Ventricular Atrial Extension Presenting as Network-Level Cognitive and Gait Dysfunction.pubmed.ncbi.nlm.nih.gov
38. The Dual Role of Connexins in Stroke, Neurotrauma, Neurodegenerative and Psychiatric Disorders: A Global Systematic Review.pubmed.ncbi.nlm.nih.gov
39. Primary central nervous system diffuse large B-cell lymphoma in fourth ventricle: Case report and literature review.pubmed.ncbi.nlm.nih.gov
40. Radiologic features of primary intracranial ectopic germinomas: Case reports and literature review.pubmed.ncbi.nlm.nih.gov
41. Butterfly Glioma of the Corpus Callosum Mimicking Rapidly Progressive Dementia.pubmed.ncbi.nlm.nih.gov
42. Third ventricle non-Hodgkin lymphoma: An unusual presentation of primary central nervous system lymphoma.pubmed.ncbi.nlm.nih.gov
43. Understanding a mass in the paraspinal region: an anatomical approach.pubmed.ncbi.nlm.nih.gov
44. Bilateral lesions of the basal ganglia and thalami (central grey matter)-pictorial review.pubmed.ncbi.nlm.nih.gov
45. Neurolymphomatosis: A Comprehensive Review of Clinical and Imaging Features.pubmed.ncbi.nlm.nih.gov
46. Preoperative assessment of recurrence-prone subregions within the peritumoral region of glioblastoma: a comparison between diffusion kurtosis and diffusion tensor imaging.pubmed.ncbi.nlm.nih.gov
47. Primary Intramedullary Histiocytic Sarcoma with Leptomeningeal Dissemination: Imaging, Pathologic, and Molecular Correlation.pubmed.ncbi.nlm.nih.gov
48. Radiological and FDG-PET imaging features of Epstein-Barr virus-positive primary central nervous system lymphomas.pubmed.ncbi.nlm.nih.gov
49. Management of pneumonia by the emergency radiologist.pubmed.ncbi.nlm.nih.gov
50. Myxoid glioneuronal tumor of the septum pellucidum with concurrent dual <i>PDGFRA</i> and <i>FGFR3</i> gene mutations: a case report and literature review.pubmed.ncbi.nlm.nih.gov
51. Case Report: Giant acute hemorrhagic colloid cyst in the septum pellucidum-foramen of Monro region with obstructive hydrocephalus in an 8-month-old infant.pubmed.ncbi.nlm.nih.gov
52. Brain morphometry and cognition in late-onset glutaric aciduria type 1: scoping review and novel insights from a case report.pubmed.ncbi.nlm.nih.gov
53. Analysis of Upper Facial Weakness in Central Facial Palsy Following Acute Ischemic Stroke.pubmed.ncbi.nlm.nih.gov
54. Distinct neuroanatomical and neuropsychological features of Down syndrome compared to related neurodevelopmental disorders: a systematic review.pubmed.ncbi.nlm.nih.gov
55. Tumor apparent diffusion coefficient combined with the lipid-to-creatine ratio for preoperative differentiation of primary central nervous system lymphoma from high-grade glioma: a single-center diagnostic model development and internal validation study.pubmed.ncbi.nlm.nih.gov
56. Intraoperative Flow Cytometry for the Differentiation of Glioblastomas from Metastatic Brain Tumours: A Preliminary Prospective Study.pubmed.ncbi.nlm.nih.gov
57. Targeting Classical <i>EGFR</i> Mutations in Lung Cancer: Twenty Years of Progress and Beyond.pubmed.ncbi.nlm.nih.gov
58. Cosmic Signs in Radiology: A Pictorial Review.pubmed.ncbi.nlm.nih.gov
59. Spinal Cord Toxoplasmosis: Mapping the Journey of a Rare Entity Through a Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
60. Tumor-like Lesions in Primary Angiitis of the Central Nervous System: The Role of Magnetic Resonance Imaging in Differential Diagnosis.pubmed.ncbi.nlm.nih.gov
61. Evaluation of imaging methods in cerebral toxoplasmosis.pubmed.ncbi.nlm.nih.gov
62. Receptor-Assisted Nanotherapeutics for Overcoming the Blood-Brain Barrier.pubmed.ncbi.nlm.nih.gov
63. Shining New Light on Biological Systems: Luminescent Transition Metal Complexes for Bioimaging and Biosensing Applications.pubmed.ncbi.nlm.nih.gov
64. EACR 2025 Congress: Innovative Cancer Science, 16-19 June 2025.pubmed.ncbi.nlm.nih.gov
65. Complex vasculitic overlap: temporal arteritis complicating suspected neuro-behçet disease with recurrent ischemic injury.pubmed.ncbi.nlm.nih.gov
66. Post-therapy imaging of adult brain tumours: patterns, pitfalls, and practical framework.pubmed.ncbi.nlm.nih.gov
67. Primary central nervous system vasculitis and headache: Ten themes.pubmed.ncbi.nlm.nih.gov
68. Spontaneous Renal Hemorrhage Secondary to Acute Pyelonephritis: An Unusual Presentation of Wunderlich Syndrome.pubmed.ncbi.nlm.nih.gov
69. Cerebral Venous Sinus Thrombosis Mimicking Tumor Hemorrhage: Successful Anticoagulation in a Resource-Limited Setting.pubmed.ncbi.nlm.nih.gov
70. Chromosomal 1p Duplication in a Pediatric Patient: A Case Report.pubmed.ncbi.nlm.nih.gov
71. CNS involvement by EBV-positive extranodal T-cell lymphoma harboring STAT3 Y640F mutation following allogeneic hematopoietic stem cell transplantation: A case report.pubmed.ncbi.nlm.nih.gov
72. Cerebral toxoplasmosis: Parasitology, diagnosis, treatment, and prevention - a narrative review.pubmed.ncbi.nlm.nih.gov
73. Blastomycosis of the Central Nervous System.pubmed.ncbi.nlm.nih.gov
74. Nonbrain metastases seen on magnetic resonance imaging during metastatic brain tumor screening.pubmed.ncbi.nlm.nih.gov
75. Adrenal Incidentaloma.pubmed.ncbi.nlm.nih.gov
76. Treating the invisible target: treatment planning targeting the microscopic tumor spread in gliomas.pubmed.ncbi.nlm.nih.gov
77. Spectral CT and Photon-counting Detector CT: Principles and Applications in Neuroradiology.pubmed.ncbi.nlm.nih.gov
78. CT-based radiomics and ablation margin quantification for predicting local tumor progression in Stage I NSCLC after radiofrequency ablation.pubmed.ncbi.nlm.nih.gov
79. Severe Central Nervous System Fungal Infection Following Tirabrutinib Administration in a Patient with Refractory Primary Central Nervous System Lymphoma: A Case Report.pubmed.ncbi.nlm.nih.gov
80. Primary breast diffuse large B-cell lymphoma mimicking breast carcinoma: A case report and literature review.pubmed.ncbi.nlm.nih.gov
81. Paraneoplastic Myopathy as a Possible Initial Presentation of Sporadic Burkitt Lymphoma in an Immunocompetent Adult: A Case Report.pubmed.ncbi.nlm.nih.gov
82. Multiterritory Acute Ischemic Stroke with Bilateral Middle Cerebellar Peduncle T2/FLAIR Hyperintensities in the Setting of a Fatal Systemic Arterial Thrombotic Process: A Case Report.pubmed.ncbi.nlm.nih.gov
83. Electroencephalographic Aspects in a Sheep with Coenurosis.pubmed.ncbi.nlm.nih.gov
84. Bi-allelic loss-of-function variants in TMEM63B cause syndromic surfactant dysfunction disorder.pubmed.ncbi.nlm.nih.gov
85. Structural MRI Differences in the Thalamus, Caudate Nucleus, and Interthalamic Adhesion in Dogs With Idiopathic Epilepsy.pubmed.ncbi.nlm.nih.gov
86. Interpretable multimodal learning for integrating neuroimaging and genetic data in Alzheimer's disease.pubmed.ncbi.nlm.nih.gov
87. Multimodal imaging analysis of autosomal recessive Parkinson's disease.pubmed.ncbi.nlm.nih.gov
88. Severe Recurrent Hemorrhage of an Oncogenic Vertebrobasilar Junction Aneurysm Following Stent-Assisted Coil Embolization in Metastatic Testicular Choriocarcinoma.pubmed.ncbi.nlm.nih.gov
89. Central Nervous System Tuberculoma in Qatar: Clinical, Radiological, and Pathological Insights From a Rare Case With Literature Review.pubmed.ncbi.nlm.nih.gov
90. Pediatric CLIPPERS: Expanding the Neuroimaging Spectrum of a Rare Steroid-Responsive Neuroinflammatory Syndrome-A Systematic Review.pubmed.ncbi.nlm.nih.gov
91. Cerebrovascular Manifestations of Neurosarcoidosis - An Overview.pubmed.ncbi.nlm.nih.gov
92. Case Report: Cerebrospinal fluid cytology as a diagnostic clue in hemorrhagic glioblastoma mimicking hypertensive intracranial hemorrhage.pubmed.ncbi.nlm.nih.gov
93. Neuroimaging in inborn errors of immunity: More than infections.pubmed.ncbi.nlm.nih.gov
94. Clinical Approach to Myelopathy Diagnosis.pubmed.ncbi.nlm.nih.gov
95. A systematic approach to detection of epileptogenic foci on imaging: protocols, entities, search pattern, and reporting tools.pubmed.ncbi.nlm.nih.gov
96. Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke.pubmed.ncbi.nlm.nih.gov
97. Diffusion-weighted MRI in neuro-oncology.pubmed.ncbi.nlm.nih.gov
98. Neurological complications of transplantation: part I: hematopoietic cell transplantation.pubmed.ncbi.nlm.nih.gov
99. Perilesional Diffusion Tensor Imaging for Differentiating Malignant and Benign Causes of Intracerebral Hemorrhage.pubmed.ncbi.nlm.nih.gov
100. Diagnostic accuracy of dynamic contrast-enhanced CT for meningioma subclassification and its role in evaluating tumor vascularity.pubmed.ncbi.nlm.nih.gov
101. Quantitative magnetic resonance imaging for accurate delineation of radiotherapy: a narrative review.pubmed.ncbi.nlm.nih.gov
102. The Lupus Damage Index Revision Program: Results From the Item Generation and Reduction Phases.pubmed.ncbi.nlm.nih.gov
103. A comparative study of large-vessel and small-vessel primary angiitis of the central nervous system: insights from a Chinese single-center retrospective cohort.pubmed.ncbi.nlm.nih.gov
104. The lupus damage index revision program: Results from the item generation and reduction phases.pubmed.ncbi.nlm.nih.gov
105. Neuroradiology of acute pathologies in adults with hematologic malignancies: a pictorial review.pubmed.ncbi.nlm.nih.gov
106. Pathophysiology, clinical manifestations, and prognostic insights of cerebral fat embolism: a literature review.pubmed.ncbi.nlm.nih.gov
107. Microstructure mapping with time-dependent diffusion MRI differentiates primary central nervous system lymphoma from glioblastoma.pubmed.ncbi.nlm.nih.gov
108. Primary CNS Lymphoma Presenting With Seizures in a Virologically Suppressed HIV Patient With Near-Normal CD4: A Case Report From Uganda.pubmed.ncbi.nlm.nih.gov
109. The first reported case of <i>Balamuthia</i> amoebic encephalitis initially presenting as anti-NMDAR encephalitis.pubmed.ncbi.nlm.nih.gov
110. Case Report: Probable CLIPPERS in a patient with cutaneous T-cell lymphoma in remission: 5-year follow-up.pubmed.ncbi.nlm.nih.gov
111. Case report: Intravascular large B cell lymphoma mimicking acute demyelinating encephalomyelitis after SARS-CoV-2 reinfection: diagnostic value of advanced MRI techniques and the literature review with the assistance of ChatGPT.pubmed.ncbi.nlm.nih.gov
112. Unusual primary central nervous system lymphoma location involving the fourth ventricle and hypothalamus.pubmed.ncbi.nlm.nih.gov
113. Modern techniques of magnetic resonance in the evaluation of primary central nervous system lymphoma: contributions to the diagnosis and differential diagnosis.pubmed.ncbi.nlm.nih.gov

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