PMC6095976_01
MRI at initial presentation showing volume and signal increase of the right medial temporal lobe with focal extension to neocortical areas on T2/FLAIR images (a) without contrast enhancement (b,c). In contrast, follow-up MRI showing multiple lesions in axial T2/FLAIR (d) with contrast enhancement (e,f). On histopathological examination, a malignant lymphoid tumor (g) with expression of CD20 (h) and some intermingled reactive CD3-positive lymphocytes (i) was encountered. Ki67/Mib1 proliferation index accounted for 92% (j). All scale bars represent 50 mum.
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MRI showed volume and signal increase within right medial temporal lobe with focal extension to neocortical areas on T2/FLAIR images without contrast enhancement (Figures 1a-c). Moreover, non-contrast-enhancing T2/FLAIR-hyperintense signals were detected in the posterior leg of the right internal capsule extending to the right cerebral crus (Figure 1a), the right lentiform nucleus and the left corona radiata. CSF examination showed unchanged findings, but MRI revealed progression of the previously described non-contrast enhancing T2/FLAIR lesions with new contrast-enhancing lesions adjacent to the posteriorhorn of the right lateral ventricle and central of the left parietal lobe (Figures 1d-f). Biopsy from a contrast-enhancing left precentral lesion revealed a malignant lymphoid tumor of high cellularity composed of blastic cells with large pleomorphic nuclei (Figures 1g-j).