PMC9846770_01
Axial T1WI (A) and T2WI (B) show a fusiform lesion isointensity to gray matter in the right cavernous sinus (CS). T1WI (D) and T2WI (E) show a crescent-shaped extra-axial mass in the right fronto-temporo-parietal region dura. The right CS lesion (J) extends into the posterior cranial fossa into the internal auditory canal and encircles the auditory nerve and facial nerve (K). Post-contrast T1-weighted (C, F, G, H, I) images show intense homogeneous enhancement of the mass lesions with both dural tails visible. The leptomeningeal involvement of the right extra-axial dura lesion shows serrated enhancement on contrast-enhanced T2-FLAIR (L). APTw image (M) shows a relative homogeneous tumor mass, with APTw signal intensity rates of 2.2%-4.3% (mean: 3.1%).
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One mass was fusiform in the cavernous sinus (CS) area ( Figures1 A-C ), the other was crescent-shaped beneath the fronto-temporo-parietal region skull ( Figures1 D-F ). Figures 1G-I ). For more details, for the tumor beneath cranium, short striped flow voids signals inside and moderate edema zone around ( Figure 1E ) are were observed. As the CS lesion, the ipsilateral cavernous segment of internal carotid artery had no stenosis ( Figures 1J, K ). The right CS lesion spread to the posterior cranial fossa, involving the internal auditory canal and encircled the cisternal segment of the right trigeminal nerve, auditory nerve and facial nerve ( Figures 1J, K ). The serrated enhancement was due to leptomeningeal involvement along the inner side of the fronto-temporo-parietal region lesion on the post-contrast fluid-attenuated inversion recovery (FLAIR) image ( Figure 1L ). APTw image ( Figure 1M ) showed relatively hyperintense compared to the normal brain tissue, the mean APTw value of the tumor was 3.1% (2.2%-4.3%).
Microscopic examination shows a diffuse infiltrate of lymphocytes, plasma cells, and some cells with intermediate lymphoplasmacytic morphology (A). The lymphocytic infiltrates were positive for CD20 (B), CD21 (C), and CD79a (D). These lymphocytes and plasma cells are monotypic for kappa light chain (E) expression, and they are essentially negative for lambda light chain (F).
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Microscopic examination of the biopsy revealed fragments of dense connective tissue infiltrated by closely packed, medium-sized, and monomorphic lymphocytes and scattered plasma cells ( Figure 2A ). The lymphocytic infiltrates were positive for CD20 ( Figure 2B ), CD138, CD38, CD21 ( Figure 2C ), CD79a ( Figure 2D ), and MUM1. These lymphocytes and plasma cells are monotypic for kappa light chain ( Figure 2E ) expression, and they are essentially negative for lambda light chain ( Figure 2F ).
Axial T1WI (A), T2WI (B), and T2-FLAIR (C) demonstrate postoperative alterations in CS. In axial T1WI (D), T2WI (E), and T2-FLAIR (F) images, an obvious edema zone can be seen in the right parietal frontal brain, which may be related to brain changes after radiotherapy. No tumor recurrence was found in post-contrast T1-weighted (G-L) images.
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Follow-up of the initial MRI 8 months after the operation illustrated no evidence of tumor recurrence ( Figures 3A-L ).