PMC4630777_01
Brain magnetic resonance image showing leptomeningeal/periventricular enhancement, but no mass lesion
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F1
Magnetic resonance imaging of the brain showed findings suggestive of multiple prior subarachnoid hemorrhage, hydrocephalous as well as diffuse leptomeningeal and ependymal enhancement [Figure 1].
(a) Cerebrospinal fluid containing large lymphoma cells (DQ stain; x200). (b) Primary effusion lymphoma cells with pleomorphic nuclei and smaller background lymphocytes and monocytes (DQ stain; x600)
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F2
ThinPrep (Pap stain) and cytospin (DQ stain) preparations demonstrated the presence of several large malignant cells [Figure 2].
Actively dividing primary effusion lymphoma cells (DQ stain; original magnification x600)
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F3
Mitotic figures were apparent in many of these large cells [Figure 3].
Cytospin showing LNA-1 (human herpesvirus-8) positive tumor cells (immunocytochemistry; x400)
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F4
Flow cytometric analysis demonstrated that the large cells (2.1% of the total population) were CD20 negative, CD19 dim positive, and CD38 positive [Figure 4], but were insufficient for definite characterization of light chain expression.
Flow cytometric analysis showing that large lymphocytes (red), 2.1% of the total population, were (a) CD20 negative, CD19 dim positive, and (b) CD38 positive (blue: B-cells, grey: Other lymphoid cells including T-cells and NK-cells)
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F5
An immunostain for LNA-1 (HHV8) was positive in the large cells [Figure 5].