PMC3036638_01
Computed tomography scan of the brain (with contrast) showing ill-defined hypodensity lesion with multiple hypodensity spots at bilateral parieto-occipito-temporal regions. The lesion was more on the right than the left cerebral hemisphere.
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A computed tomography (CT) scan of the brain showed multiple hypodensity lesions at bilateral occipito-parieto-frontal and cerebellar regions consistent with cerebral infarction (Figure 1).
MRI scan of the brain demonstrating diffuse multi-stage intraparenchymal infarction and hemorrhage at both cerebral and cerebellar hemispheres, initially considered to be vasculitis.
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A magnetic resonance imaging (MRI) scan of the brain showed diffuse multistage intraparenchymal infarctions and hemorrhages in the bilateral cerebral and cerebellar hemispheres (Figure 2).
Magnetic resonance angiogram of the brain demonstrating normal patency of bilateral internal carotid arteries, anterior cerebral arteries, middle cerebral arteries, posterior cerebral arteries, and vertebrobasilar arteries.
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However, magnetic resonance angiography (MRA) of the brain revealed normal intracranial vasculature (Figure 3).
Skin biopsy. A) Low magnification showed no apparent diagnostic abnormality (hematoxylin and eosin stain, 40 x magnification). B) High magnification revealed a few large lymphoma cells in the lumens of capillaries in subcutaneous fat (hematoxylin and eosin stain, 400 x magnification). C) Large lymphoma cells marked with CD20. D) Scattered CD3+ small lymphocytes were noted among the large lymphoma cells. Copyright 2005 Blackwell Publishing Ltd. Reproduced with permission.
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Interestingly, the pathological findings of the random skin biopsies showed intravascular large B cell lymphoma (IVBL, positive for CD20) (Figure 4).