PMC3740612_01
MRI demonstrating multiple hemorrhagic foci in bilateral cerebral hemispheres.
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F1
A MRI [Figure 1] was repeated, which showed multiple hemorrhagic foci in bilateral cerebral hemispheres, with perilesional edema and mild mass effect.
CT scan demonstrating increase in multiple hypodensities in bilateral cerebral hemispheres.
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F2
An urgent CT scan [Figure 2] revealed an increase in size of multiple scattered hypodense lesions involving the deep white and subcortical matter in both cerebral hemispheres compared with the recent MRI.
A leptomeningeal vessel showing luminal occlusion by large pleomorphic lymphoma cells (H&E x 200); CD20 stains the intraluminal tumour cells (CD20 x 200); The proliferative marker Ki-67 labels majority of the intraluminal tumor cells (Ki67 x 200)
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F3
The blood vessels of the leptomeninges, cerebral cortex and white matter demonstrated multifocal occlusion by large lymphoid cells with pleomorphic nuclei, prominent nucleoli and mitotic activity [Figure 3a] and [Figure 4]. The intraluminal lymphoid cells showed strong expression of the B lymphocyte marker C20 by immunoperoxidase staining [Figure 3b]. Ki67 labeled the majority of the atypical lymphoid cells [Figure 3c].
White matter with vessels showing luminal occlusion by lymphoma cells (H&E x 400)
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F4
The blood vessels of the leptomeninges, cerebral cortex and white matter demonstrated multifocal occlusion by large lymphoid cells with pleomorphic nuclei, prominent nucleoli and mitotic activity [Figure 3a] and [Figure 4].