PMC3087939_01
Cerebral MRI: (a) coronal view T1 with gadolinium injection: left cerebellar nodular lesion with central necrotic zone and peripheral contrast enhancement. (b) Coronal view T1 without gadolinium injection: periventricular localization of multiple cerebral hypersignal nodular lesions.
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The MRI performed 3 days later detected diffuse periventricular cerebral and cerebellar contrast-enhanced lesions (hypersignal Flair) (Figure 1).
Cerebellar biopsy: (a) nodular granulomatous lesion with mononuclear cells (Hematein-eosin x 40). (b) Atypical cells with mitosis (*) (Hematein-eosin x 40). (c) Staining with anti-CD20 (x40): atypical cells are stained. (d) Staining with anti-EBV-LMP1 (x40): a lot of cells are stained.
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 The histological study (Figure 2) showed a heterogeneous necrotising lesion, with cellular remnants, granulomatous clusters of giant cells, with circumvented nuclei and well visible nucleoli, which looked like lymphoplasmocyte cells.
Pulmonary localisation of lymphomatoid granulomatosis. Transverse CT view, with contrast injection in parenchymatous window showing nodular lesions taking contrast. (a) At initial diagnosis. (b) 2 years after reduction in the immunosuppression and rutiximab therapy.
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The CT scan of the thorax showed 6 pulmonary nodules of tissular density in the left lung and one pulmonary nodule in the right lung (Figure 3(a)). The thoracic CT scan showed only a single nodule (Figure 3(b)).