PMC9217145_01
Magnetic resonance imaging shows a solitary mass lesion at the cerebral falx with contrast enhancement on T1-weighted imaging (A: axial, B: coronal, and C: sagittal views) and no apparent findings of invasion and edema around the brain on T2-weighted imaging (D). Intraoperative photographs show that the lesion is elastic soft tissue. First, the right side of the lesion is removed (E, arrowheads), and next the left side is also removed (F, arrows). Finally, the dura mater attachment of the mass is cut and removed (G).
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Magnetic resonance (MR) imaging showed a solitary mass lesion at the cerebral falx with contrast enhancement on T1-weighted imaging, and there were no apparent findings of invasion and edema around the brain on T2-weighted imaging (Fig. 1A-D). Finally, the dura mater attachment of the lesion was cut and removed (Fig. 1E-G).
Surgical specimen stained with hematoxylin-eosin shows diffuse infiltration of small lymphocytes and plasma cells. There is some proliferation of large lymphocytes with folded nuclei, high-density chromatin, and inconspicuous nucleoli (A: x100 and B: x400). Immunohistochemical examinations show that these cells exhibit positive staining for CD20 (C) and CD79a (D), and there are CD3-positive T-cells (E). The atypical lymphocytes are stained for mind bomb 1 (F). The plasma cells are positive for the lambda immunoglobulin light chain (G) but lack kappa light chain expression (H).
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Histological examination showed diffuse infiltration of small lymphocytes and plasma cells (Fig. 2A). There was also some proliferation of large lymphocytes with folded nuclei, high-density chromatin, and inconspicuous nucleoli (Fig. 2B). These small and large lymphocytes were positive for CD20, CD79a, and multiple myeloma 1, suggesting B-cell lymphoma (Fig. 2C and D). T-cells (Fig. 2E), CD68-positive cells, and S-100 positive cells. The atypical lymphocytes were stained for mind bomb 1 (Fig. 2F). The Ki-67 labeling index was 44%. The plasma cells showed dominant expression of lambda immunoglobulin light chain (IgL) and lack of kappa light chain expression on immunohistochemistry (Fig. 2G and H).
18F fluoro-2-deoxyglucose positron emission tomography shows high accumulations at the left pterygoid muscle (A) and the right transverse processes of the thoracic vertebrae (B), and mild accumulation at the right ilium bone (C). The plan of gamma knife surgery shows a maximum dose of 30 Gy and a marginal dose of 15 Gy (yellow lines) for thickening of the dura mater with contrast enhancement (D). Magnetic resonance images two years later show no evidence of recurrence (E and F).
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Ophthalmologic evaluations showed no other areas of disease. 18F fluoro-2-deoxyglucose positron emission tomography showed high accumulations at the left pterygoid muscle and right transverse processes of the thoracic vertebrae, and mild accumulation at the right ilium bone, indicating disseminated lesions (Fig. 3A-C). Therefore, gamma knife surgery was performed with a maximum dose of 30 Gy and a marginal dose of 15 Gy (Fig. 3D). Two years later, she was alive without neurological deterioration, and MR imaging showed no recurrence (Fig. 3E and F).