PMC3547986_01
Magnetic resonance imaging of the brain from 2003 revealing left-sided cerebritis.
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F1
A magnetic resonance imaging (MRI) study of the brain demonstrated a left cerebritis (Fig. 1).
Extension of disease in temporal squamosal; sequestrum is adjacent to emissary vein.
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F2
A repeat CT study revealed extension of her disease into the petrous squamosa, with bony sequestra abutting an emissary vein (Fig. 2); this was attributed to recurrence of pathology in residual air cells.
Evolution of new disease in retrofacial air cell tract.
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F3
On previous imaging this region had been normal, occupied by a few air cells and bone marrow (Figs. 3 A & B).
Biopsy of the mastoid shows marked fibrosis with an infiltrate comprising plasma cells and other inflammatory cells (hematoxylin and eosin stain).
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F4
Staining of previously obtained tissue from her mastoid revealed a lymphoplasmacytic infiltrate with large areas of storiform fibrosis (Fig. 4).
The majority of the plasma cells stained for IgG4 (immunohistochemical stain, hematoxylin counterstain).
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F5
T-cells were present, but plasma cells predominated (Fig. 5). There were also cholesterol clefts noted on the biopsy.