• Costansia Bureta, Nayuta Higa, Ryutaro Makino, Tomoko Takajo, Hajime Yonezawa, Hiroyuki Uchida, and Koji Yoshimoto.
• Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
• World Neurosurg. 2020 Nov 1; 143: 490-494.

BackgroundCases of primary central nervous system lymphoma manifesting with hemorrhage are very rare, with only a few previous studies available.Case DescriptionA 49-year-old man presented with occipital headache and visual disturbance for the past 4 months. Computed tomography showed a high-density area involving the left basal ganglia, with surrounding vasogenic edema. Head T2∗-weighted imaging showed a hypointense signaling area. Edematous changes and a midline shift were observed on fluid attenuated inversion recovery magnetic resonance imaging. Radiologic features were highly suggestive of intracerebral hemorrhage. Methylprednisolone pulse therapy improved his symptoms transiently and reduced the size of the lesion. Nonetheless, there was recurrence 1 month later. The patient was referred to our institution; a biopsy was performed, and a diffuse large B-cell lymphoma was diagnosed. After 3 cycles of high-dose methotrexate and whole-brain radiation therapy, his symptoms improved, and there were no signs of recurrence.ConclusionsWe report a very rare case of diffuse large B-cell lymphoma manifested with intratumoral hemorrhage. This case indicates the importance of regular clinical and radiologic follow-up, histopathologic examination, and combined treatment with high-dose methotrexate and whole-brain radiation therapy.Copyright © 2020 Elsevier Inc. All rights reserved.

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