Clinical Analysis of Intracranial B Lymphoblastic Lymphoma Misdiagnosed as Subdural Hematoma

ZHANG Peng; WANG Zhiqiang; LIU Hui; LYU Peidong; CHENG Xiafei; ZHANG Junjiang; GUO Shihao; WEI Hailiang

doi:10.3969/j.issn.1002-3429.2025.13.003

Abstract：Objective To explore the clinical features,causes of misdiagnosis and preventive measures of intracranial B lymphoblastic lymphoma.Methods The clinical data of a patient with intracranial B lymphoblastic lymphoma who was misdiag-nosed in November 2022 were retrospectively analyzed.Results The patient presented with sudden speech difficulties.After cranial CT examination,it was misdiagnosed as subdural hematoma.After corresponding treatment,there was some improvement.Symptoms occurred multiple times within one month.After re-admission,a plain and enhanced brain MRI scan was performed,which showed an abnormal enhanced shadow under the left frontal and temporal cranial plates.The possibility of a malignant lesion of the dura mater was considered:a malignant meningioma or lymphoma?The patient's family requested a transfer to a higher-level hospital for further treatment.A resection of the intracranial space-occupying lesion was performed at the higher-level hospital,and the pathological examination confirmed it as B lymphoblastic lymphoma.The misdiagnosis lasted one month.After surgical treat-ment,the patient improved and was discharged.Conclusion Intracranial B lymphoblastic lymphoma belongs to primary central nervous system lymphoma(PCNSL),which is a rare extranodal lymphoma.PCNSL may be misdiagnosed in radiology and has similar imaging features to many diseases,including meningiomas,subdural or epidural hematomas.When receiving such patients in clinical practice,if the initial therapeutic effect of the disease is not favorable,intracranial B lymphoblastic lymphoma should be considered and pathological examination should be performed as soon as possible.