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NEUROIMAGE
Year : 2020  |  Volume : 68  |  Issue : 1  |  Page : 238-239

Intracranial Hodgkin's Lymphoma


1 Radiology Department of Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady in Prague; First Medical Faculty, Charles University in Prague, Czech Rep
2 Radiology Department of Third Faculty of Medicine, Charles University in Prague and Faculty Hospital Kralovske Vinohrady in Prague, Czech Rep

Date of Web Publication28-Feb-2020

Correspondence Address:
Dr. Hana Malikova
Radiology Department of Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady in Prague, Srobarova 50, Prague . 10034
Czech Rep
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.279692

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How to cite this article:
Koubska E, Weichet J, Malikova H. Intracranial Hodgkin's Lymphoma. Neurol India 2020;68:238-9

How to cite this URL:
Koubska E, Weichet J, Malikova H. Intracranial Hodgkin's Lymphoma. Neurol India [serial online] 2020 [cited 2020 Jul 4];68:238-9. Available from: http://www.neurologyindia.com/text.asp?2020/68/1/238/279692




A 33-year-old woman suffered from right-side hearing loss, headache, and vertigo. On MRI, two intracranial lesions were found, both arising from dura. One lesion was situated in the right temporo-occipital area, the second on the right tentorium with supratentorial and infratentorial propagation. Both lesions showed low signal on T1WI and T2WI with significant postcontrast enhancement with no signs of diffusion restriction. Lesions were surrounded by vasogenic edema [Figure 1]A. Moreover, there was a tumorous infiltration of parotid regions on both sides, soft tissue masses in the right external meatus and the middle ear cavity and partly infiltrated left mastoid cells [Figure 1]B. The diagnosis of the lymphoma was suggested. The biopsy of the infiltrated parotid gland proved surprisingly Hodgkin's lymphoma (HL) [Figure 2]. Haemato-oncology treatment was initiated and one month later the partial regression of brain lesions was apparent [Figure 3].
Figure 1: (A) Initial brain MRI. Two intracranial meningeal lesions (arrows) with low signal on T2WI (a) and DWI (b), isointense on T1WI (c), strongly enhancing after gadolinium contrast agent injection (d). (B) Initial brain MRI. Both parotid glands are affected, the left one with nodular lesions (a - T2WI; arrow) showing diffusion restriction (c – DWI; arrow). The infiltration in the external auditory canal and the middle ear cavity is visible on T2WI (b; arrow) and DWI (d; arrow)

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Figure 2: Histopathology. Hodgkin and Reed/Sternberg cells as the hallmark cells of Hodgkin's lymphoma are present

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Figure 3: Comparison of the initial brain MRI and the brain MRI one month later (during the chemotherapy). Regression of the intracranial meningeal lesions is evident both on T2WI and postcontrast T1WI (empty arrows). Fluid content of mastoid cells on the right side also decreased (full arrow)

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Intracranial affection by HL is very rare, estimated less than 0.5% of all HL cases, usually reported as case reports.[1],[2] Opposed to the demonstrated case, absolute majority of brain lymphomas are non-Hodgkin's lymphomas manifested as multiple parenchymal lesions with diffusion restriction and strong gadolinium contrast enhancement.[3],[4],[5] Both isolated meningeal affections and free diffusion are rare.[4],[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

HM and JW are supported by Charles University research program PROGRES Q28.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hirmiz K, Foyle A, Wilke D, Burrell S, Brownstone R, Ago C, et al. Intracranial presentation of systemic Hodgkin's disease. Leuk Lymphoma 2004;45:1667-71.  Back to cited text no. 1
    
2.
Vera R Jr, Enriquez R, Papac R. Hodgkin's disease, intracranial involvement. Report of a case and review of the literature. Am J Clin Oncol 1985;8:73-6.  Back to cited text no. 2
    
3.
Agarwal PA, Menon S, Smruti BK, Singhal BS. Primary central nervous system lymphoma: A profile of 26 cases from Western India. Neurol India 2009;57:756-63.  Back to cited text no. 3
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4.
Malikova H, Koubska E, Weichet J, Klener J, Rulseh A, Liscak R, et al. Can morphological MRI differentiate between primary central nervous system lymphoma and glioblastoma? Cancer Imaging 2016;16:40.  Back to cited text no. 4
    
5.
Koubska E, Weichet J, Malikova H. Central nervous system lymphoma: A morphological MRI study. Neuroendocrinol Lett 2016;37:318-24.  Back to cited text no. 5
    


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