PMC7767717_01
Magnetic resonance imaging (MRI) showing 5x3.5 cm abnormal nonuniformly contrasted mass with hypointensity on T1-weighted image (left) and with hyperintensity on T2-weighted image (right) in the right temporal lobe. (A) MRI at first consultation; (B) MRI after MPV administration (at day 17 after admission); (C) MRI after FCR administration (at day 34 after admission); (D) MRI after Ibr administration (at day 54 after admission).
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Magnetic resonance imaging (MRI) revealed a 5x3.5 cm nonuniformly contrasted mass in the right temporal lobe that appeared hypointense on T1-weighted and hyperintense on T2-weighted images (Figure 1A). MRI showed that the tumor size remained unchanged (Figure 1B) and PB-lymphocyte reduction was poor (Figure 4), indicating resistance to the MPV treatment. Although the PB lymphocytes decreased steadily (Figure 4) without recurrence of intracranial hypertension-related symptoms, no reductive effect on the intracranial tumor was observed on contrast-enhanced MRI (Figure 1C). However, 2 weeks later, contrast-enhanced MRI revealed no reductive effect, and diplopia and headaches had recurred (Figure 1D).
Brain specimens (cranioscopic biopsy) showing infiltration of small monoclonal lymphocytes with expression of CD5 and CD20 (upper left, H&E x40; upper right, H&E x100; lowerleft CD5 x100; lower right, CD20 x100).
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A diagnostic cranioscopic biopsy was performed, which revealed infiltration of small monoclonal lymphocytes with expression of CD5, CD20 (Figure 2), and CD79A, but without CD10, CD23, cyclin D1, or evidence of transformation.
CLL cells from peripheral blood at first consultation and admission and BM at admission showed mature small monoclonal lymphocytes with narrow cytoplasm, concentrated nuclei, and partially aggregated chromatin without transformation to a large cell type (H&E x40 and x200).
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BM lymphocytes had a normal karyotype without poor prognostic factors, deletion 17p, deletion 11q, or transformation (Figure 3), which was compatible with a diagnosis of CLL.
Clinical course of WBC and lymphocyte counts after treatment.
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MRI showed that the tumor size remained unchanged (Figure 1B) and PB-lymphocyte reduction was poor (Figure 4), indicating resistance to the MPV treatment. Although the PB lymphocytes decreased steadily (Figure 4) without recurrence of intracranial hypertension-related symptoms, no reductive effect on the intracranial tumor was observed on contrast-enhanced MRI (Figure 1C).