PMC10424439_01
Axial view MR imaging (T2 FLAIR). The image shows a heterogeneous region centered in the right thalamus/gangliocapsular region, involving the entire right basal ganglia, including the putamen, globus pallidus, caudate, and the posterior limb of the internal capsule as well as the posterior aspect of the external capsule. There is a 1-cm right-to-left midline shift and compression of the lateral ventricles and the third ventricle with subsequent mild dilatation of the lateral ventricles concerning obstructive hydrocephalus.
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F1
Additionally, there were multiple ring-enhancing lesions in the right thalamic region (with the largest measurement of 9 mm) and midbrain (with the largest measurement of 7 mm), with a surrounding T2 hyperintense region attributable to edema (Figure 1).
Immunohistochemistry of brain tissue revealed numerous CD68+ histiocytes (Mag. X 20).
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F2
Immunohistochemistry of the brain tissue also revealed rare CD20+ perivascular cells, numerous CD68+ histiocytes (some of which are microglia), and a Ki67 nuclear proliferation index of 2-3% (Figure 2).
Axial view T2 FLAIR MRI imaging 2 years after initial presentation showed complete resolution of brain lesions.
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F3
A 2-year follow-up brain MRI later showed no new or enhancing lesions (Figure 3) although the patient continued to have minimal residual deficits in mobility and vision.