PMC6881765_01
(a) Axial view T1 with Gadolinium at presentation, showing right posterior temporal lesion with a T1 hypointense rim suggestive of atypical stroke. Images of new findings at the previous area of stroke to evaluated new neurologic symptoms: (b) axial view T1 with Gadolinium showing an internal increase in size and (c) axial view FLAIR showing a heterogeneous lesion with hypointense foci within associated surrounding edema and enfacement of posterior horn or right lateral ventricle.
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fig1
Initial magnetic resonance imaging (MRI) showed multiple mixed signal intensity mass lesions on the right posterior temporal and occipital lobes with areas of hemorrhage and restricted diffusion suggestive of blood products. (Figure 1(a)). The patient underwent evaluation by his primary care doctor who recommended a brain MRI, showing a right parieto-occipital mass (Figure 1(b)).
CNS biopsy: (a) lymphomatous infiltrate is predominantly perivascular that pushes into the surrounding brain parenchyma, which is hemorrhagic with numerous hemosiderin-laden macrophages. Intermediate and high-power photomicrographs of the perivascular lymphoid infiltrate: (b) the infiltrate is composed predominantly of lymphoid cells, which are small with mature nuclear chromatin and regular, rounded nuclear borders. (c) More invasive, rather than pushing, infiltrate involving the brain parenchyma. Immunohistochemistry: (d) PAX-5, (e) coexpression of CD5, (f) partial coexpression of CD23, and (g) cyclin-D1 is negative in the neoplastic lymphoid cells.
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fig2
By immunohistochemistry, the lymphoma cells stained positive for CD5, PAX-5, and CD23 and negative for CD20, CD3, BCL6, and cyclin-D1. (Figure 2).