A Case of Primary Central Nervous System Lymphoma: Crucial Implication in Multiphasic Physical and Brain Check-up

We report a 75-year-old man with primary central nervous system (CNS) lymphoma which was detected on the first physical and brain check-up. He developed headache, depression and the loss of body weight for recent two months, and received multiphasic health check-up in our institute. On brain check-up (Stratis II, Hitachi Medical Co., Japan), T2-weighed imaging revealed multiple hyperintense signal areas in the periventricular white matter and basal ganglia. The differential diagnosis between brain tumors and multiple lacunar infarctions was needed because he had hypertension and severe degree of diabetes mellitus. Fluid-attenuated inversion recovery imaging disclosed markedly multiple hyperintense mass lesions. Gadolinium-enhanced T1-weighted imaging showed strong and homogenous enhancement. Brain tumor was confirmed by these features of MRI. Physical check-up showed no advanced malignant tumors in other organs. At first, brain metastatic tumor of unknown origin was suspected on physical and brain check-up. The definite diagnosis of primary CNS lymphoma was made by stereotactic brain biopsy in a University hospital. He was recovered after administration of steroid and radiotherapy. Primary CNS lymphoma was detected in one of 2,312 adult subjects who received brain check-up between April 1, 2001 and January 31, 2002 in our institute. This unique case points out that multiphasic health tests, including simultaneous brain check-up, contribute to the early discover of fetal brain tumors. The combined data of physical and brain check-up could have benefits for the selection of further laboratory studies and therapeutic strategy in patients with brain tumors.