PMC6080144_01
Preoperative axial (a), coronal (b), and sagittal (c) MRI scans showing a heterogeneous T1 contrast enhancing lesion involving the right Meckel's cave and the lateral wall of the cavernous sinus corresponding in the histopathological analysis to an Epstein-Barr-virus-associated B-cell lymphomatoid granulomatosis
SNI-9-148-g001.jpg
PMC6080144_01_SNI-9-148-g001.jpg
F1
T1 contrast enhancing lesion in the right Meckel's cave extending to the lateral wall of the cavernous sinus [Figure 1].
LYG lesion was isointense in native T1 (a), T2 (b), and CISS (c) sequences and showed no diffusion restriction (d) in preoperative MRI scans
SNI-9-148-g002.jpg
PMC6080144_01_SNI-9-148-g002.jpg
F2
The lesion was isointense in T2 and constructive interference in steady state (CISS) sequences and did not show diffusion restriction. There was no evidence of vascular compression of the trigeminal nerve in the cerebellopontine angle [Figure 2].
Axial contrast enhanced T1-weighted MRI immediately postoperative confirmed a successful removal of the lesion (a) and there was no evidence of LYG relapse (b) 6 months after surgery
SNI-9-148-g003.jpg
PMC6080144_01_SNI-9-148-g003.jpg
F3
Dolenc approach. During surgery, the lesion was amenable to be separated from the dural envelope of the cavernous sinus and was completely resected [Figure 3]. Under surveillance after resection, there was no cranial granuloma recurrence in further neuroimaging studies performed every 6 months during the follow-up [Figures 3 and 5], and EBV load remained lower than 103/mm3; hence, there was no need of other specific therapies.
Histological tissue sections showing transmural vascular infiltration of lymphocytes, (a) epithelioid cells and histiocytes (b) characteristic of LYG
SNI-9-148-g004.jpg
PMC6080144_01_SNI-9-148-g004.jpg
F4
Histopathological examination established the diagnosis of Epstein-Barr-virus-associated B-cell lymphomatoid granulomatosis (LYG) by showing the typical transmural vascular infiltration of lymphocytes, epithelioid cells, and histiocytes with oval nucleus and discrete nucleoles, necrotic epithelioid, and giant cells on the borders and reticulin fiber infiltration [Figure 4].
Axial (a) and coronal (b) contrast weighted T1 MRI images after 41-months' follow-up showing no local recurrence of LYG
SNI-9-148-g005.jpg
PMC6080144_01_SNI-9-148-g005.jpg
F5
Under surveillance after resection, there was no cranial granuloma recurrence in further neuroimaging studies performed every 6 months during the follow-up [Figures 3 and 5], and EBV load remained lower than 103/mm3; hence, there was no need of other specific therapies.