PMC5498208_01
Color fundus images of the left eye over the course of disease. (A) An image of the fundus at the initial visit. The details of the fundus are not visible due to the dense vitreous opacity. (B) An image of the fundus one month after intravitreal methotrexate treatment administered six times, showing complete resolution of the optic and retinal edema.
1349-7235-56-1409-g001.jpg
PMC5498208_01_1349-7235-56-1409-g001.jpg
g001
The fundoscopic image of the left eye obtained on admission is shown in Fig. 1A. The treatment resulted in a dramatic improvement, and the patient achieved complete response (CR; Fig. 1B). As shown in Fig. 4, the repeat regions of LMP1 detected in the vitreous and brain lesion were identical.
Magnetic resonance imaging (MRI) of the CNS lesion. MRI revealed hyperintense lesions with T2-weighted fluid-attenuated inversion recovery (FLAIR) in the right occipital lobe.
1349-7235-56-1409-g002.jpg
PMC5498208_01_1349-7235-56-1409-g002.jpg
g002
T2-weighted fluid-attenuated inversion recovery (FLAIR) imaging MRI in the right occipital and parietal lobes and the precentral gyrus, and a left visual field defect was detected on an ophthalmological evaluation (Fig. 2). The tumor was suspected to be high-grade glioma and was removed by craniotomy; however, the pathological diagnosis was ENKL.
Pathological findings of the CNS lesions. (A) Hematoxylin and Eosin staining. Perivascular infiltration of atypical lymphoid cells observed in the CNS lesion. (B-E) The infiltrating cells were positive for CD3 (B), CD56 (C), Epstein-Barr virus (EBV) (D), and TIA1 (E). EBV was detected by in situ hybridization (ISH) of EBV-encoded mRNA (EBER). The original magnification was 1,000x. (F) The positive control for EBER-ISH using the specimen from EBV-positive gastric cancer.
1349-7235-56-1409-g003.jpg
PMC5498208_01_1349-7235-56-1409-g003.jpg
g003
A sequence analysis of LMP1 from the DNA isolated from the vitreous and the CNS specimen. The sequence of exon 3 of LMP1 detected in DNA from the vitreous, brain, and B95-8 cells (Accession No. X01995.1) serving as control. The regions bounded by squares indicate regions identical between the vitreous and brain DNA.
1349-7235-56-1409-g004.jpg
PMC5498208_01_1349-7235-56-1409-g004.jpg
g004
As shown in Fig. 4, the repeat regions of LMP1 detected in the vitreous and brain lesion were identical.