Difficulties in diagnosing primary cerebral lymphoma (clinical case)

Primary cerebral lymphomas account for about 5% of CNS neoplasms and 1–2% of non-Hodgkin lymphomas. The article presents a clinical case of multifocal brain lesion with a long-term (more than 3 years) course of the disease, similar to the demyelinating process in the MRI picture, clinically considered as multiple sclerosis, chronic encephalitis or sarcoidosis, which ended by a lethal outcome with an immunohistochemically verified primary diffuse B-large cell lymphoma of the brain. Prolonged course of the disease and the effectiveness of glucocorticosteroids suggest the presence of isolated brain lymphomatoid granulomatosis which could develop in the background of multiple sclerosis during three years prior to malignization. Cerebral biopsy could help in the earlier diagnosis of the disease, thus it should be the diagnostic procedure of choice for verifying the pathological multifocal process in diagnostically complicated cases.