PMC5069375_01
Head CT revealing a lacrimal gland mass (a). Lacrimal gland mass on initial Axial FLAIR (b). Restricted diffusion in the lacrimal glass mass (c and d). Repeat MRI after initiation of prednisone revealing decreased size of lacrimal lesion (e). Hypermetabolic foci corresponding to lymph nodes in bilateral neck, axillary regions, chest, pelvis, and inguinal regions on whole-body PET/CT (f). Prominent hypermetabolic lesion in the right lateral orbit before prednisone (g). No evidence of hypermetabolic lesions or regional hypometabolism within the brain on PET/MRI 5 months after prednisone and infliximab (h).
CRINM2016-7464587.001.jpg
PMC5069375_01_CRINM2016-7464587.001.jpg
fig1
Head CT revealed a lacrimal gland mass (Figure 1(a)). Brain MRI with contrast revealed an enhancing right lacrimal gland mass measuring up to 2.65 cm with restricted diffusion suspicious for lymphoma in addition to chronic small vessel disease (Figures 1(b), 1(c), and 1(d)). Subsequent body PET/CT scan showed prominent hypermetabolic lesion in the right lateral orbit and lymph nodes in bilateral neck, axillary regions, chest, pelvis, and inguinal regions, most consistent with lymphoma (Figures 1(f) and 1(g)). A repeat brain MRI with contrast done at one and two months after initiation of steroids showed marked decrease in size of the right lacrimal lesion to about 10 x 13 mm in the axial plane (Figure 1(e)). Brain PET/MRI five months after steroid and infliximab treatment showed normal brain metabolism pattern (Figure 1(h)).