Multimodality imaging of the hypothalamic lymphoma in an adult male

Abstract

Introduction: We report the case of A 64-year-old man was hospitalized due to a 2 days history of general weakness, vomiting, muscle pain, and mental confusion. Routine laboratory and gastrointestinal examinations provided unremarkable. HIV-test was negative. In our case, emergency non-contrast computed tomography (NECT) (Fig.1A), contrast-enhanced CT (CECT) (Fig.1B, C, D) and magnetic resonance imaging (MRI) (Fig.2A-D) of the brain confirmed a 38x32-mm mass in the third ventricle-hypothalamic region, enhanced by contrast with suprasellar extension, optic chiasm involvement and surrounded by perilesional edema. DWI reveals restricted diffusion within the tumor with high signal intensity on DWI and corresponding low signal intensity on the ADC map (Fig.3A, B). The 1H-MR spectroscopy findings with mild elevation of the Cho peak and reduction of the NAA peak (Fig.4), Cho/Cr ratio is 6.61 (not shown), strongly suggest a tumor. The results of the extensive studies for systemic lymphoma were negative, suggesting a primary hypothalamic lymphoma. The patient underwent surgery, after the 3 weeks from the initial diagnosis CT scan. Histopathological examination showed a malignant large B cell lymphoma (CD20+).