Cerebral Amyloidoma Associated with B-Cell Non-Hodgkin Lymphoma

Background:
- Isolated amyloidomas represent the least common form of amyloid depositions in the brain. Cases are often misclassified as intracerebral neoplasms.
- Conventional MRI findings are variable. They may be hypointense, hyperintense, or isointense on T1WI. On T2WI, they are heterogeneous with areas of low and high intensity, and they enhance with the use of IV contrast.
- To date, around 50 cases have been reported.
Clinical Presentation:
- Symptoms depend on the lesion localization.
- Seizures, headache, cognitive decline, and focal motor and sensory symptoms have been reported in some patients.
Key Diagnostic Features:
- Irregular and heterogeneous contrast-enhancing lesion
- No diffusion restriction
- No necrosis or edema; minimal mass effect
- Low rCBV
- Increased choline, decreased creatine and N-acetyl-aspartate; increase in both Cho/Cr and Cho/NAA ratios
- There are no lipid or lactate peaks as normally observed in lymphomas.
Differential Diagnoses:
- Intracerebral neoplasm: No diffusion restriction; increase in Cho/NAA and Cho/Cr ratios (high-grade glioma); low rCBV and increasing myo-inositol level (low-grade glioma)
- Demyelinating lesions: Contrast-enhancing; no diffusion restriction; low rCBV; slightly increasing Cho/NAA ratio and myo-inositol level
- Abscess: Contrast-enhancing; diffusion restriction depending on the lesion stage and the use of antibiotics; low rCBV
Treatment:
- Chemotherapy and radiotherapy

November 2, 2017

A 70-year-old man experiencing difficulty with articulating language and spoken object naming in the last month

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