PMC8326066_01
Initial pre-operative radiographic appearance of mass lesion. (a) Pre-operative axial T1 MRI with contrast demonstrating contrast-enhancing lesions in the right occipital lobe, right precentral gyrus, and within the right periventricular region. (b) Axial PET imaging and (c) PET/CT demonstrating a hypermetabolic lesion in the right posterior occipital lobe. (d) Axial SWAN imaging demonstrates a hemorrhagic component of the right occipital lesion.
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F1
MRI of the brain demonstrated a contrast-enhancing 3.2 cm lesion in the right occipital lobe, a 1.8 cm enhancing lesion in the right precentral gyrus, and multiple smaller enhancing lesions in the right periventricular region with associated vasogenic edema but no mass effect [Figure 1a]. PET/CT showed no evidence of systemic malignancy but visualized right posterior temporal, occipital and parietal lobe lesions [Figure 1b and c]. Susceptibility-weighted angiography (SWAN) imaging demonstrated a hemorrhagic component of the right occipital lobe lesion [Figure 1d].
Histologic characterization of frozen biopsy sample. (a) x2 and (b) x10 H and E demonstrating brisk parenchymal and perivascular infiltrate of small lymphocytes in a background of marked reactive astrocytosis. (c) CD20 immunohistochemistry highlights many small B-cells in a predominantly perivascular distribution. (d) CD3 immunohistochemistry highlights numerous small T-cells. Scale bars: 500 microm for (a), 100 microm for (b), 200 microm for (c) and (d).
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F2
These cells were CD3 [Figure 2c], CD163, Iba1, and CD68 positive. B cell immunohistochemistry was scantly positive [Figure 2d]. The T-cell population was found to be composed of more CD4+ than CD8+ cells.
Post-operative MRI demonstrating decrease in size of enhancing lesions. Radiographic improvement in contrast-enhancing regions following surgical excision and prolonged high-dose dexamethasone therapy.
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F3
The following MRI demonstrated post-surgical changes with significant decrease in the size of the right occipital lesion [Figure 3].