Giant anterior communicating artery aneurysm infiltrated with a primary cerebral lymphoma: Case report

OBJECTIVE AND IMPORTANCE: Central nervous system lymphomas exhibit angiotro pic characteristics. Nevertheless, direct association with an intracranial aneurysm is very rarely reported. We present a case of a giant aneurysm inf iltrated with a large cell non-Hodgkin's lymphoma. The incidence of primary central nervous system lymphoma is increasing, and similar cases may becom e more frequent in the future. CLINICAL PRESENTATION: A 65-year-old man had presented with a giant anterio r cerebral artery aneurysm, new onset of seizures, aphasia, and hemiparesis . The aneurysm was treated with Guglielmi detachable coils. Six months late r, the patient exhibited fever and neurological deterioration. Magnetic res onance images suggested an enhancing lesion posterior to the neck of the an eurysm. Antibiotic treatment given elsewhere was unsuccessful. INTERVENTION: A craniotomy for a suspected abscess was performed, with remo val of the aneurysm and clipping of the neck. The aneurysm sac appeared to be filled with thrombus and pus. The results of aerobic, anaerobic, and fun gal cultures were negative. Postoperative magnetic resonance images demonst rated a residual mass, posterior to the aneurysm within the striatum and th e internal capsule. Histological examination of the aneurysm wall revealed a large B-cell lymphoma. The diagnosis was confirmed by a stereotactic biop sy. Radiation therapy resulted in a transient decrease in the size of the l esion. CONCLUSION: Although the tumor was not apparent on the initial imaging stud ies, it may have been the cause of the patient's presenting symptoms. Infil tration of the aneurysm wall by the lymphoma also raises the possibility of a causal relationship. As the incidence of primary central nervous system lymphoma is reported to be on the increase, awareness this uncommon associa tion of an aneurysm and malignant lymphoma is of value.