Primary CNS Lymphoma- a Squash Diagnosis

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A 52-year-old male presented with complaints of headache, vomiting, unstable gait falling to one side for a duration of 6 months. CT scan of brain revealed a single, deep seated hyperdense, intraparenchymal lesion in the left cerebellar hemisphere. The mass was of size (3x2) cm with well defined border showing homogeneously contrast enhancement and exhibiting peripheral edema along with features of obstructive hydrocephalus. Other investigations revealed no abnormality in hemogram and peripheral smear examination. HIV status was negative. The patient had no palpable enlarged peripheral lymph node. No deep seated lymph node was detected even after thorough searching by Ultrasonography & CT Scan. Preoperative finding revealed that the mass was unencapsulated, grayish, soft and was richly vascular. Squash cytosmears showed easy spreading of tissue. On lower magnification smears were cellular showing even gradient of cellular density with clustering at places. Intermediate magnification revealed monomorphic population of cells with lack of cellular cohesion admixed with good number of tingible body macrophages (Figure 2). Background showed large number of degenerated nuclei, apoptotic bodies along with numerous lymphoglandular bodies.

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