PMC4553635_01
Spinal magnetic resonance imaging performed on the initial presentation demonstrating an increased signal intensity, which was more pronounced in the gray matter, on a T2-weighted image at the level of Th3 (a and b: Sagittal T2-weighted image, c: Axial T2-weighted image at the level of Th3)
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F1
In addition, the findings of cranial magnetic resonance imaging (MRI) and computed tomography (CT) of the thorax and abdomen were unremarkable, whereas whole spine MRI revealed increased signal intensity, which was more pronounced in the gray matter, on a T2-weighted image obtained at the level of Th3 [Figure 1].
Magnetic resonance imaging of the brain performed on the second presentation showing diffuse bilateral asymmetrical predominantly subcortical hyperintense white matter lesions on diffusion-weighted imaging (a). Cranial magnetic resonance angiography demonstrated no abnormalities (b). XP (c) and computed tomography (d) of the chest showed patchy areas of ground-glass opacity in both lungs
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F2
MRI showed several nonenhancing hyperintense lesions in the subcortical white matter [Figure 2a]. MR angiography demonstrated no intracranial arterial stenosis or occlusion [Figure 2b]. In addition, the patient developed dyspnea, and XP and CT of the chest showed patchy areas of ground-glass opacity in both lungs [Figure 2c and d].
Pathological findings of the random skin biopsy. Large hyperchromatic cells are filling the lumen of the small blood vessels in the subcutaneous adipose tissue (a: H and E, x400). These cells were positive for CD20 (b: x400) and negative for CD3 (c: x400), positive for Ki-67 (MIB-1) (d: x400) confirming the diagnosis of intravascular large B cell lymphoma
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F3
All skin biopsy specimens showed obliteration of the small vessels in subcutaneous fat tissue by lymphoma cells, allowing for a diagnosis of IVL [Figure 3].