Question
A 54-year-old African American male presents with progressive ataxia and left hemiparesis. He has a past medical history significant for focal segmental glomerulonephritis. Family history is notable for sarcoidosis in his mother as well as breast cancer in his sister. MRI brain shows a solitary homogeneously enhancing lesion within the right internal capsule that is hyperintense to gray matter on T2 with restricted diffusion on diffusion-weighted imaging. Brain biopsy reveals a diffuse large B cell lymphoma. Which of the following is the next best step in management?
| A. |
Corticosteroid administration
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| B. |
Systemic staging
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| C. |
Chemotherapy
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| D. |
Whole-brain radiotherapy
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Show Answer
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Correct Answer � B
Explanation
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Answer : B Systemic staging
Systemic staging is warranted prior to treatment because 4% to 12% of patients thought to have primary central nervous system lymphoma are found with systemic disease.
Primary central nervous system lymphoma comprises 5% of all primary brain tumors and 1% of non-Hodgkin lymphomas. The most common subtype is the diffuse large B cell variant.
Magnetic resonance imaging often shows hypointense lesions on T1, that are hyperintense on T2 with restricted diffusion on diffusion-weighted imaging. Post-contrast enhancement is typical. Up to 60% of lesions are solitary in immunocompetent individuals, while 30% to 80% of immunosuppressed patients present with multiple lesions.
Males are more frequently affected than females in immunocompetent individuals as well as in patients with AIDS. Lesions have a predilection for the periventricular white matter, as well as the frontal lobe and basal ganglia.
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