Multiple peripherally “ring” enhancing lesions of the brain in a young man: A diagnostic dilemma

Multiple peripherally “ring” enhancing lesions of the brain in a young man: A diagnostic dilemma

Aiman Ahmad1, Asmaa Atteya1, Afraa Moustafa2, Afaf Al-Battah2, Mohamed Talaat3, Abdulrazzaq Haider4, Mohamed A Yassin2

1 Department of Medicine, Hamad Medical Corporation.
2 Haematology Section, Medical Oncology, NCCCR, Hamad Medical Corporation.
3 Radiology Department, Hamad Medical Corporation.
4 Department of Laboratory Medicine, Hamad Medical Corporation.

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Primary central nervous system (CNS) lymphomas are tumours localised only in the brain, spinal cord, and rarely, the eyes (i.e. involving only the CNS). These can be detected by imaging modalities, namely computed tomography (CT) and magnetic resonance imaging (MRI), in which they appear as lesions, most often with surrounding enhancement (i.e. peripherally-enhancing or ring-enhancing lesions). However, similar lesions can be seen in a variety of other conditions and differentiating these diagnoses by imaging alone is difficult. We report a case of primary CNS lymphoma in a 21-year old gentleman who was misdiagnosed as and treated for neurocysticercosis and brain tuberculomas due to misleading investigation results, in addition to the relative unlikelihood of CNS lymphoma in this patient compared to other similar individuals. Fortunately, appropriate management was initiated as soon as CNS lymphoma was confirmed by biopsy of the brain lesion, with good treatment response.

Keywords: Primary CNS lymphoma; Peripherally-enhancing lesions; Ring-enhancing lesions; Diagnostic dilemma; MRI

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How to cite this article:
Aiman Ahmad, Asmaa Atteya, Afraa Moustafa, Afaf Al-Battah, Mohamed Talaat, Abdulrazzaq Haider, Mohamed A Yassin. Multiple peripherally “ring” enhancing lesions of the brain in a young man: A diagnostic dilemma. International Journal of Case Reports, 2018 3:54. DOI:10.28933/ijcr-2018-12-0407


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