Necrotic Primary Central Nervous System Lymphoma in an Immunocompetent Patient: A Case Report and Literature Review

Primary lymphoma that arises de novo from the central nervous system (CNS) is most commonly a non-Hodgkin's B-cell lymphoma and by definition lacks the presence of disease outside the CNS. It demonstrates a characteristic imaging appearance on computed tomography (CT) and magnetic resonance imaging (MRI) exams related to its inherent hypercellularity. On CT, primary CNS lymphoma (PCNSL) demonstrates a hyperdense appearance; on MRI, it commonly demonstrates restricted water diffusion on diffusion-weighted sequences and homogeneous enhancement on post-contrast sequences. We present a case of primary CNS lymphoma in an immunocompetent patient with progressive necrosis and loss of restricted diffusion on diffusion-weighted imaging (DWI) with an atypical enhancement pattern. We further provide a review of the literature regarding the CT and MRI appearance of primary CNS lymphoma and discuss the role of immune status in determining the imaging characteristics of this disease process.