A High Grade Diffuse B Cell Lymphoma Patient Presented with Isolated Large Space Occupying Lesion in the Frontal Lobe Mimicking High Grade Glioma or Fungal Granuloma Case Report and Review of Literature


  • Saeed Mazher Department of Neurosurgery, Baqai University Hospital, Nazimabad
  • Abdul Ali Khan Department of Neurosurgery, Baqai University Hospital, Nazimabad
  • Abdul Latif Department of Neurosurgery, Baqai University Hospital, Nazimabad
  • Abdul Khaliq Department of Neurosurgery, Baqai University Hospital, Nazimabad
  • Shafat ullah Department of Neurosurgery, Baqai University Hospital, Nazimabad


Rare unusual case, high grade DLBCL, Large Intracerebral Frontal Lobe Lesion, Positron Emission Tomographic scanning, Radiotherapy.


Primary high grade B-cell-type cerebral lymphoma is a rare subtype of primary central nervous system lym-phoma. We herein report an unusual case of diffuse B-cell lymphoma in a young lady who presented with a large intracerebral space occupying lesion without extracranial involvement. The notable aspects of this case include the patient was having a short clinical history of symptom onset, rapid neurological deterioration having severe midline shift on imaging and a final histopathological diagnosis was consistent with high-grade diffuse B cell lymphoma after subtotal surgical resection. Extracranial extension of the disease was unremarkable on PET scanning. This case highlights the challenges neurosurgeons face, especially in the emergency setting, when the disease manifests in varied presentations. 


1-James O. Armitage. Approach to Patients with Diffuse Large B – Cell Lymphoma Mayo Clin Proc. 2012 Feb; 87: 161–171.
2. Armitage J.O. How I treat patients with diffuse large B – cell lymphoma. Blood, 2007; 110: 29–36.
3. Kubuschok B1, Held G, Pfreundschuh M. Management of Diffuse Large B – Cell Lymphoma (DLBCL) Cancer Treat Res. 2015; 165: 271-88. 4. Sacho RH1, Kogels M, du Plessis D, Jowitt S, Josan VA. Primary diffuse large B – cell central nervous sys-tem lymphoma presenting as an acute space – occupy-ing subdural mass. J Neurosurg. 2010; 113: 384-7. 5. Liao CH1, Lin SC2, Hung SC3 et al. Primary large B – cell lymphoma of the fourth ventricle. J Clin Neurosci. 2014; 21: 180-3.
6. Ferreri A.J. How I treat primary CNS lymphoma. Blo-od, 2011; 118: 510–522.
7. Khimani N.B., Ng A.K., Chen Y.H., Catalano P., Silver B., Mauch P.M. Salvage radiotherapy in patients withrecurrent or refractory primary or secondary central nervous system lymphoma after methotrexate – based chemotherapy. Ann Oncol. 2011; 22: 979–984.
8. Phan J., Mazloom A., Jeffrey Medeiros L. Benefit of consolidative radiation therapy in patients with diffuse large B – cell lymphoma treated with R-CHOP chemo-therapy. J Clin Oncol. 2010; 28: 4170–4176.
9. Pfreundschuh M., Kuhnt E., Truemper L. 6 – Year fol-low-up of the MINT study suggests a role for radiothe-rapy to bulky disease. Ann Oncol. 2011; 22 (suppl. 4) [Abstract 029].
10. Dorth J.A., Chino J.P., Prosnitz L.R. The impact of radiation therapy in patients with diffuse large B – cell lymphoma with positive post-chemotherapy FDG – PET or gallium – 67 scans. Ann Oncol. 2011; 22: 405–410.
11. Tsukamoto N., Kojima M., Hasegawa M. The useful-ness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and a comparison of (18)F-FDG-pet with (67) gallium scintigraphy in the evaluation of lymphoma: relation to histologic subtypes based on the World Health Organization classification. Cancer, 2007; 110: 652–659.
12. Seam P., Juweid M.E., Cheson B.D. The role of FDG – PET scans in patients with lymphoma. Blood, 2007; 110: 3507–3516.
13. Wirth A., Seymour J.F., Hicks R.J. Fluorine-18 fluoro-deoxyglucose positron emission tomography, gallium-67 scintigraphy, and conventional staging for Hod-gkin’s disease and non-Hodgkin's lymphoma. Am J Med. 2002; 112: 262–268.
14. Elstrom R.L., Leonard J.P., Coleman M., Brown R.K. Combined PET and low – dose, non-contrast CT scan-ing obviates the need for additional diagnostic contrast-enhanced CT scans in patients undergoing staging or re-staging for lymphoma. Ann Oncol. 2008; 19: 1770–1773.
15. Specht L. 2-[18F]fluoro-2-deoxyglucose positron – emission tomography in staging, response evaluation, and treatment planning of lymphomas. Semin Radiat Oncol. 2007; 17: 190–197.
16. Jerusalem G., Beguin Y., Fassotte M.F. Whole – body positron emission tomography using 18F-fluorodeoxy-glucose for post-treatment evaluation in Hodgkin's dise-ase and non-Hodgkin's lymphoma has higher diagnostic and prognostic value than classical computed tomogra-phy scan imaging. Blood, 1999; 94: 429–433.
17. Spaepen K., Stroobants S., Dupont P. Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([18F]FDG) after first – line chemotherapy in non-Hodgkin’s lymphoma: is [18F]-FDG-PET a valid alternative to conventional diagnostic methods? J Clin Oncol. 2001; 19: 414–419.
18. Mikhaeel N.G., Timothy A.R., Hain S.F., O’Doherty M.J. 18-FDG-PET for the assessment of residual mas-ses on CT following treatment of lymphomas. Ann Oncol. 2000; 11: 147–150.
19. Naumann R., Vaic A., Beuthien – Baumann B. Pro-gnostic value of positron emission tomography in the evaluation of post-treatment residual mass in patients with Hodgkin’s disease and non-Hodgkin’s lymphoma. Br J Haematol. 2001; 115: 793–800.
20. Dupuis J., Itti E., Rahmouni A. Response assessment after an inductive CHOP or CHOP – like regimen with or without rituximab in 103 patients with diffuse large B-cell lymphoma: integrating 18fluorodeoxyglucose positron emission tomography to the International Wor-kshop Criteria. Ann Oncol. 2009; 20: 503–507.
21. Cheson B.D., Pfistner B., Juweid M.E. Revised respo-nse criteria for malignant lymphoma. J Clin Oncol. 2007; 25: 579–586.






Case Reports