PMC6473054_01
Brain and spine MRI findings. The initial axial fluid-attenuated inversion recovery (A), axial T1-weighted gadolinium-enhanced (B), and axial diffusion weighted imaging (C) brain MRI showed bilateral irregular hyperintense lesions around the ventricles with enhancement on the right temporal lobe. (D) Sagittal T2-weighted cervical spine MRI showed hyperintensity longitudinally extending from the cervical to the thoracic cord. (F-H) Six months later, the follow-up axial T2-weighted brain MRI (F) and diffusion weighed imaging (H) showed a mass lesion in the right temporal lobe with homogenous enhancement on T1-weighted gadolinium-enhanced series (G); Sagittal T2-weighted cervical spine MRI showed regredient lesions in the cervical cord (E). (I,J) After the chemotherapy, the right temporal lesion on T1-weighted gadolinium-enhanced series (I) was significantly regredient and necrotic; No abnormal signal was displayed on diffusion weighted imaging (J). R indicates right and L indicates left.
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F1
Brain MRI revealed multifocal periventricular lesions with gadolinium enhancement in the left medial temporal lobe (Figures 1A-C). Spine MRI revealed longitudinally extensive abnormal signal extending from the cervical to the thoracic cord (Figure 1D). However, the 6-month follow-up brain MRI revealed an unexpected enhancing temporal mass with extensive perifocal edema (Figures 1F-H). Repeat spine MRI revealed decreasing lesions without contrast enhancement (Figure 1E). Repeat brain MRI showed necrosis of the original mass lesion, no new lesions were observed (Figures 1I,J).
Brain biopsy findings. Hematoxylin and eosin staining revealed diffusely distributed atypical lymphoid cells (A). Immunohistochemistry study revealed strong positive staining of the lymphoma cells for CD20 B cell marker (B), and the Ki-67 index was 70% (C). Magnification, x400 for all.
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F2
Histopathological findings of the specimen demonstrated DLBCL (Figure 2).
Whole-body PET/CT findings. PET/CT imagings showed abnormal hypermetabolic lesions in the left testicle (A) and in multiple abdominal and retroperitoneal lymph nodes (B).
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F3
Abnormal hypermetabolism was found in the left testicle and in multiple abdominal and retroperitoneal lymph nodes (Figure 3).