The document discusses the case of a 56-year-old male patient presenting with lesions in the brain. The top differential diagnoses listed are glioblastoma, primary CNS lymphoma, progressive multifocal leukoencephalopathy, and demyelination. Various MRI techniques are discussed for evaluating the lesions. After reviewing the imaging, the final diagnosis is determined to be primary CNS lymphoma, based on the characteristic enhancing lesion seen within the basal ganglia and periventricular white matter. Key features of primary CNS lymphoma on imaging and pathology are described.

1. RENAI RADIOLOGY
RENAI MEDICITY

2. • 56 year old male patient

20. TOP DIFFERENTIAL DIAGNOSIS
• Acquired toxoplasmosis
• Glioblastoma (GBM)
• Primary CNS Lymphoma
• Abscess
• Progressive multifocal leukoencephalopathy (PML)
• Demyelination

22. • DWI
• PERFUSION
• CONTRAST ENHANCED SCANS
• GRADIENT IMAGING
• DIFFUSION TRACTOGRPHY
• MR SPECTROSCOPY
• Arterial Spin labelling

23. TOP DIFFERENTIAL DIAGNOSES
• Acquired toxoplasmosis
• Glioblastoma (GBM)
• Primary CNS Lymphoma
• Abscess
• Progressive multifocal leukoencephalopathy (PML)
• Demyelination

24. TOP DIFFERENTIAL DIAGNOSES
• Acquired toxoplasmosis
• Abscess

34. TOP DIFFERENTIAL DIAGNOSES
• Acquired toxoplasmosis
• Glioblastoma (GBM)
• Primary CNS Lymphoma
• Abscess
• Progressive multifocal leukoencephalopathy (PML)
• Demyelination

35. TOP DIFFERENTIAL DIAGNOSES
• Acquired toxoplasmosis
• Glioblastoma (GBM)
• Primary CNS Lymphoma
• Abscess
• Progressive multifocal leukoencephalopathy (PML)
• Demyelination

36. TOP DIFFERENTIAL DIAGNOSIS
• Glioblastoma (GBM)
• Primary CNS Lymphoma
• Progressive multifocal leukoencephalopathy (PML)
• Demyelination

37. TOP DIFFERENTIAL DIAGNOSES
• Glioblastoma (GBM)
• Primary CNS Lymphoma
• Progressive multifocal leukoencephalopathy (PML)
• Demyelination

44. TOP DIFFERENTIAL DIAGNOSES
• Glioblastoma (GBM)
• Primary CNS Lymphoma
• Progressive multifocal leukoencephalopathy (PML)
• Demyelination

45. TOP DIFFERENTIAL DIAGNOSES
• Glioblastoma (GBM)
• Primary CNS Lymphoma
• Progressive multifocal leukoencephalopathy (PML)
• Demyelination

46. TOP DIFFERENTIAL DIAGNOSES
• Glioblastoma (GBM)
• Primary CNS Lymphoma

55. TOP DIFFERENTIAL DIAGNOSES
• Glioblastoma (GBM)
• Primary CNS Lymphoma

56. TOP DIFFERENTIAL DIAGNOSES
• Glioblastoma (GBM)
• Primary CNS Lymphoma

57. DIAGNOSIS
• Primary CNS Lymphoma

58. Malignant primary CNS neoplasm primarily composed of B Lymphocytes.Disease
outside the nervous system is absent at the time of Dx.
IMAGING
• Best diagnostic clue: Enhancing lesion within basal
ganglia &/or periventricular white matter
• Often involve/ cross corpus callosum
○ Frequently contact, extend along ependymal surfaces
• Classically hyperdense on CT (helpful for diagnosis)
• Diffusely enhancing periventricular mass in immunocompetent

59. • May see hemorrhage or necrosis in immunocompromised
• DWI: Low ADC values
• PWI: Low rCBV ratios

64. 24 year old female was treated over the last three
months for a pulmonary embolism diagnosed at
an outside hospital. She has experienced
increasing dyspnea and recently hemoptysis and a
syncopal episode
C/P

68. Pulmonary Artery Intimal Sarcoma

69. 10 year-old male patient presents with near
syncope and small volume hemoptysis.

74. 67-year-old male with enlarging left gluteal mass. Left buttock
injury in MVA 25 years ago. Left buttock injury in a fall more
recently

84. Morel-Lavallee lesion

85. A Morel-Lavallée lesion is a closed degloving injury associated with
severe trauma which then presents as a haemolymphatic mass.