kleinzelliges lymphozytisches Lymphom (SLL)

Primary
central nervous system small lymphocytic lymphoma in the bilateral ventricles: two case reports. The solid lesions are located in the bilateral ventricles and fornix, presenting as isointense on T1WI (a, white arrow) and hypointense on T2WI (b, white arrow) without restricted diffusion (c, white arrow on DWI). Axial SWI demonstrates enlarged veins in the thalamus and located adjacent to the lateral ventricles (d). The lesions demonstrate homogeneous contrast enhancement (e-g, axial (white arrow), sagittal, and coronal T1 with contrast) and hyperperfusion on 3D-ASL MR perfusion imaging (h, black arrow). Open biopsy of the lesions shows diffuse proliferating small lymphocytes (H&E × 200) (i). CD-20 positivity of lymphocytes (× 200) (j). CSF cytology reveals malignant cells, and flow cytometry immunophenotyping reveals a lymphocyte subset with the profile of CD19+ (50.81%) (k and l)
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Primary
central nervous system small lymphocytic lymphoma in the bilateral ventricles: two case reports. The solid lesions in the bilateral ventricles presenting as isointense on T1WI (a, white arrow) and hypointense on T2WI and FLAIR images (b and c, white arrow). Striking contrast enhancement (d-f, axial (white arrow), sagittal, and coronal T1 with contrast) and hyperperfusion are demonstrated in the lesions of the bilateral ventricles (g and h, white arrow, rCBF, rCBV map). MRS from the lesion demonstrates a high Cho peak and a low NAA peak with a Cho/NAA ratio of 3.85 (i and j). CSF cytology reveals malignant cells (k)
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Small lymphocytic lymphoma (SLL) is a non-Hodgkin lymphoma affecting the B-lymphocytes of the immune system. This condition is now considered different manifestations of the same disease process as chronic lymphocytic leukemia (CLL).  On imaging, they are mostly depicted as lymphadenopathy.

Pathology

Both CLL and SLL are characterized by small and mature lymphocytes present in the bone marrow, lymphoid tissue, and peripheral blood. In SLL though, the disease is more confined to the lymph nodes rather than the bloodstream . Imaging, therefore, depicts visible nodal disease in these patients.

Differential diagnosis

In cases with a prior established diagnosis of the chronic lymphocytic leukemia, consider Richter transformation if on imaging there is the occurrence of nodal or mass-like disease on subsequent scans.

Siehe auch:
Assoziationen und Differentialdiagnosen zu kleinzelliges lymphozytisches Lymphom (SLL):