PMC5881979_01
An initial positron emission tomographic (PET)/computed tomographic (CT) scan showed bulky right axillary (arrow) and supraclavicular adenopathy with intense fluorodeoxyglucose uptake. The maximum standardized uptake value was 20.0. Additional adenopathy was present in the mediastinum and the right internal mammary region, as well as right extrapleural fat (not shown).
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No other abnormalities were identified (Figure 1).
Representative photos of the patient's chest wall mass biopsy. (A) Large atypical lymphoid cells; immunohistochemical studies for (B) CD20, (C) PAX5, and (D) CD30 (hematoxylin-eosin). Epstein-Barr virus (EBV) EBER1 messenger RNA in situ hybridization was positive (not shown as the original slides were too degraded at the time of this case report). The diagnosis of an EBV-positive diffuse large B-cell lymphoma was rendered.. All photos were taken at 400x magnification.
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The largest of the chest wall lesions was biopsied under ultrasound guidance and this revealed an EBV-positive DLBCL, which was positive for CD30, CD20, PAX5, CD79a, MUM-1, Bcl-2, and Bcl-6 and negative for CD3, CD10, CD15, and CD43 (Figures 2A to D).
(A-C) A brain MRI showed mild, nonspecific, patchy, and increased FLAIR signal throughout the white matter of both cerebral hemispheres. (D-F) A repeat brain MRI 8 days later showed extensive areas of signal abnormality in the midbrain (cerebral peduncles), centrum semiovale, corpus callosum, and basal ganglia bilaterally. These areas showed marked contrast enhancement (not shown). FLAIR indicates fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.
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An MRI of the brain, intracranial magnetic resonance (MR) angiogram, and contrast-enhanced MR angiogram of the neck showed nonspecific, patchy, increased T2 signal throughout the white matter of both cerebral hemispheres (Figures 3A to C), which was attributed to small vessel ischemic disease. A repeat brain MRI showed extensive areas of signal abnormality and diffuse confluent enhancement of the centrum semiovale, corpus callosum, basal ganglia, and cerebral peduncles bilaterally (Figures 3D to F).
The patient's autopsy brain showing perivascular and parenchymal involvement by lymphoma (hematoxylin-eosin, original magnification (A) x200 and (B) x400)). Immunohistochemical studies for CD20 at (C) x200 and (D) x400. The brain was extensively and diffusely involved by lymphoma, particularly the deep basal nuclei, midbrain, pons centrum semiovale, and corpus callosum.
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This revealed extensive lymphoma throughout the brain, particularly in the deep basal nuclei, midbrain, pons, centrum semiovale, and corpus callosum (Figure 4).