Neurológia pre prax 2/2022

Sentinel lesion and significance of rebiopsy: a case of primary CNS lymphoma

We show a case study of a 72-years old woman who firstly presented with left side brachiofacial paresis, dysarthria and headache. MR brain scan revealed a lesion in right frontal lobe with radiological findings typical for a brain lymphoma. Biopsy of this lesion was diagnostically inconclusive with unspecific inflammatory changes. MR scan performed after the biopsy showed substantial regression of the firstly found lesion and 2 new lesions, with similar radiological characteristics as the one which regressed, each one in a different hemisphere. We therefore present a case of a sentinel lesion. In our case no corticoid therapy was given before the surgery. Rebiopsy of one of the newly found lesions proved the presence of lymphoma cells and chemotherapy was initiated. We have included a commentary of each diagnostic step. We also comment on indications and risks of brain biopsy.

Keywords: primary CNS lymphoma, brain biopsy, rebiopsy, sentinel lesion