Clinical Image
Austin Oncol. 2016; 1(1): 1005.
Pachymeningeal Inflammation Mimicking Lymphoma Recurrence
Cushing T, Jordan JT* and Dietrich J
Department of Neurology, Pappas Center for Neuro- Oncology, Massachusetts General Hospital, Boston, USA
*Corresponding author: Jordan JT, Department of Neurology, Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Bldg Suite 9E, Boston, USA
Received: January 28, 2016; Accepted: February 08, 2016; Published: February 10, 2016
Clinical Image
66-year-old man with primary CNS lymphoma, in remission for four years, had a surveillance brain MRI demonstrating focal pachymeningeal enhancement (Figure 1). Examination was normal, aside from right forehead erythema after cryosurgery to a nevus. The question we faced was whether to re-initiate cytotoxic chemotherapy for presumed lymphoma recurrence, or to perform short interval follow up in case of an alternate diagnosis. Choosing the latter, repeat MRI one month later showed resolution of the abnormality (Figure 2). Two years of additional imaging confirmed no lymphoma recurrence. Cryoinjury was the suspected cause of his transient MRI changes, based on temporospatial correlation. Liquid nitrogen reaches temperatures of -100°C and [1], if delivered to the skull, may cause intracranial cryoinjury and temporary, regional inflammation [2]. Cryosurgery may be associated with focal MRI abnormalities. Further, the case illustrates the importance of clinical correlation in the interpretation of cranial imaging to avoid unnecessary tests and potentially harmful treatment.
Figure 1: (A) Axial, (B) Axial Regional Enlargement, and (C) Coronal T1-
weighted post-gadolinium images demonstrating right frontal convexity
pachymeningeal thickening and enhancement, with no underlying
parenchymal abnormality.
Figure 2: (A) Axial, (B) Axial Regional Enlargement, and (C) Coronal T1-
weighted post-gadolinium images demonstrating resolution of the prior
abnormalities 4 weeks later.
References
- Burkhart CG, Pchalek I, Adler M, Burkhart CN. An in vitro study comparing temperatures of over-the-counter wart preparations with liquid nitrogen. Journal of the American Academy of Dermatology. 2007; 57: 1019-1020.
- Kim H, Ahn M, Choi S, Kim M, Sim KB, Kim J, et al. Potential role of fibronectin in microglia/macrophage activation following cryoinjury in the rat brain: an immunohistochemical study. Brain research. 2013; 1502: 11-19.
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