PMC5519477_01
Brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). On admission, brain MRI (A) and MRA (B) were normal. On day 39, diffusion weighted imaging (DWI) showed a high intensity area in the left temporal lobe (white arrow) (C), and MRA revealed the bilateral diffuse narrowing of the M2 portion of the middle cerebral arteries (white arrowheads) (D). On day 49, DWI showed high-intensity areas in the left frontal lobe and bilateral parietal lobes (E), and MRA revealed the diffuse narrowing of the bilateral middle cerebral arteries, the anterior cerebral arteries, and the posterior cerebral arteries (white arrowheads) (F). After two cycle of R-CHOP therapy, the high intensity lesions on DWI had partially disappeared (G), and MRA showed the alleviation of the narrowing observed in the cerebral arteries (H).
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Brain MRI and MRA revealed no abnormalities (Fig. 1A, B). MRI revealed a small high-intensity lesion on diffusion-weighted imaging (DWI) in the white matter of the left temporal lobe. MRA showed the bilateral narrowing of the distal middle cerebral arteries (MCA) (Fig. 1C, D). Brain MRI on day 49 described multiple hyperintense lesions on T2-weighted imaging with diffusion restriction in the right cerebellum and both hemispheres (Fig. 1E). MRA revealed the diffuse narrowing of the bilateral anterior cerebral arteries, the MCAs, and the posterior cerebral arteries (Fig. 1F). After two cycles of R-CHOP brain MRI and MRA revealed the alleviation of vasoconstriction (Fig. 1G, H).
Skin biopsy. A histological specimen with Hematoxylin and Eosin staining, showing tumor cells in the lumen of the capillaries in subcutaneous fat (arrow) (A: low magnification, B: high magnification). The tumor cells in the capillaries were positively stained with a CD20 B-cell marker (C).
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The biopsy specimens showed intravascular large B cell lymphoma (Fig. 2).