Abstract
Fourteen cases of primary central nervous system lymphoma (PCNSL) are reported with emphasis upon correlation between the clinical course and CT findings. All primary lesions were intracranially located, presenting either single or multiple intracerebral nodules with contrast enhancement on CT scan. Mental disturbance was the most common neurological manifestation on admission. All patients were given radiation therapy as the initial treatment except one, who showed complete remission in response to corticosteroid administration. Steroid induced tumor regression on CT in 4 out of 8 patients, including 3 cases of complete remission. The initial treatment induced complete disappearance of the tumor nodules showing contrast enhancement in all but 1 patient, who died in the course of the treatment. However, clinical improvement did not always follow the disappearance of the tumor on CT scan. The patients with mental disturbance and multiple tumors tended to show an inadequate response to treatment. During the follow-up period, 9 patients died. The cause of death was attributable to the uncontrolled growth of recurrent tumors, with contrast enhancement on CT, in only 2 patients. In the remaining 7, a diffuse low density area appeared in the deep cerebral white matter, with ventricular dilatation of varying degree in the follow-up period. When CT scan disclosed these findings, the patients showed a disability similar to that of normal pressure hydrocephalus, usually in a bed-ridden state, thereafter gradually deteriorating until death. In this study, the tumor nodules showing contrast enhancement seemed to be treated with relative ease. The diffuse low density, on the contrary, was much more difficult to deal with and was considered to be a major obstacle to improving the treatment results in PCNSL.
