{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T02:39:50Z","timestamp":1780454390642,"version":"3.54.1"},"reference-count":18,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:00:00Z","timestamp":1612396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2020R1C1C1007832"],"award-info":[{"award-number":["2020R1C1C1007832"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>We report a rare case that was initially diagnosed as an inflammatory lesion and ultimately confirmed as primary central nervous system lymphoma (PCNSL) in an immunocompetent patient who was not treated with corticosteroid prior to the initial biopsy. A 70-year-old female patient presented with numbness in the left side of face, arm, and leg. Brain magnetic resonance imaging (MRI) revealed a lesion with intense gadolinium (Gd)-enhancement in the ventral portion of the midbrain. A stereotactic biopsy demonstrated mixed T-cell and B-cell infiltrating inflammatory lesions without demyelination. Three months after postoperative treatment with steroid, the lesion markedly decreased on follow-up MRI. Twenty-six months after the initial attack, she complained of dysarthria and urinary incontinence. Repetitive MRI showed a lesion with homogeneous enhancement, extensively involving the bilateral cerebral hemisphere, corpus callosum, and the right middle cerebellar peduncle. The confirmed diagnosis was diffuse large B-cell lymphoma on the second biopsy. Despite our best efforts, she died 38 months after disease onset. Based on review of the literature and our case, preceding inflammatory lesions are not always demyelinating and T-cell dominant inflammatory lesions. When the initial biopsy reveals an inflammatory lesion in an old-aged patient, the clinician should keep in mind the development of PCNSL and perform close clinical and radiological observations for a timely diagnosis.<\/jats:p>","DOI":"10.3390\/brainsci11020191","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T12:02:10Z","timestamp":1612440130000},"page":"191","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Inflammatory Brain Lesions as Omen of Primary Central Nervous System Lymphoma: A Case Report and Literature Review"],"prefix":"10.3390","volume":"11","author":[{"given":"Yeong","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun 58128, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seul","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun 58128, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-Young","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun 58128, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun 58128, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3935-0361","authenticated-orcid":false,"given":"Kyung-Hwa","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pathology, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun 58128, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1129-1064","authenticated-orcid":false,"given":"Kyung-Sub","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun 58128, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1177\/1756285608101222","article-title":"Primary CNS lymphoma","volume":"2","author":"Schlegel","year":"2009","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/bjh.14073","article-title":"Trends in primary central nervous system lymphoma incidence and survival in the U.S","volume":"174","author":"Shiels","year":"2016","journal-title":"Br. J. Haematol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/jnnp.60.1.102","article-title":"Sentinel lesions of primary CNS lymphoma","volume":"60","author":"Alderson","year":"1996","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1017\/S0317167100012610","article-title":"Inflammatory demyelinating brain lesions heralding primary CNS lymphoma","volume":"39","author":"Husseini","year":"2012","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"692.e1","DOI":"10.1016\/j.wneu.2015.11.099","article-title":"Neuroinflammation preceding and accompanying primary central nervous system lymphoma: Case study and literature review","volume":"88","author":"Lu","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2410","DOI":"10.1200\/JCO.2017.72.7602","article-title":"Primary CNS lymphoma","volume":"35","author":"Grommes","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1016\/j.jocn.2006.05.003","article-title":"Prolonged interval between sentinel pseudotumoral demyelination and development of primary CNS lymphoma","volume":"14","author":"Ng","year":"2007","journal-title":"J. Clin. Neurosci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1136\/jnnp.70.2.259","article-title":"Diagnosis of a multifocal B cell lymphoma with preceding demyelinating central nervous system lesions by single voxel proton MR spectroscopy","volume":"70","author":"Kuhlmann","year":"2001","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_9","first-page":"3606970","article-title":"Primary CNS lymphomas: Challenges in diagnosis and monitoring","volume":"21","author":"Chiavazza","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kvarta, M.D., Sharma, D., Castellani, R.J., Morales, R.E., Reich, S.G., Kimball, A.S., and Shin, R.K. (2016). Demyelination as a harbinger of lymphoma: A case report and review of primary central nervous system lymphoma preceded by multifocal sentinel demyelination. BMC Neurol., 16.","DOI":"10.1186\/s12883-016-0596-1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/bpa.12496","article-title":"Diagnostic red flags: Steroid-treated malignant CNS lymphoma mimicking autoimmune inflammatory demyelination","volume":"28","author":"Engel","year":"2018","journal-title":"Brain Pathol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"849","DOI":"10.2169\/internalmedicine.1246-18","article-title":"Recurrent epstein-barr virus-positive (EBV+) primary central nervous system lymphoma (PCNSL) in a patient with clinical features of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)","volume":"58","author":"Nagano","year":"2019","journal-title":"Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1097\/NEN.0000000000000076","article-title":"CNS lymphoma: A practical diagnostic approach","volume":"73","author":"Giannini","year":"2014","journal-title":"J. Neuropathol. Exp. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10014-020-00373-z","article-title":"Primary central nervous system lymphomas associated with chronic inflammation: Diagnostic pitfalls of central nervous system lymphomas","volume":"37","author":"Sugita","year":"2020","journal-title":"Brain Tumor Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/0022-510X(92)90065-S","article-title":"Autopsy report of primary CNS B-cell lymphoma indistinguishable from multiple sclerosis: Diagnosis with the immunoglobulin gene rearrangements analysis","volume":"111","author":"Kuroda","year":"1992","journal-title":"J. Neurol. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.3892\/ol.2014.2033","article-title":"Primary central nervous system lymphoma with preceding spontaneous pseudotumoral demyelination in an immunocompetent adult patient: A case report and literature review","volume":"7","author":"Yamamoto","year":"2014","journal-title":"Oncol. Lett."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jns.2014.06.015","article-title":"A central nervous system B-cell lymphoma arising two years after initial diagnosis of CLIPPERS","volume":"344","author":"Taieb","year":"2014","journal-title":"J. Neurol. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lister, A., Abrey, L.E., and Sandlund, J.T. (2002). Central nervous system lymphoma. Hematol. ASH Educ. Program, 283\u2013296.","DOI":"10.1182\/asheducation-2002.1.283"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/2\/191\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:20:08Z","timestamp":1760160008000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/2\/191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,4]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["brainsci11020191"],"URL":"https:\/\/doi.org\/10.3390\/brainsci11020191","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,4]]}}}