PMC4854028_01
Magnetic resonance imaging on admission. The two mass lesions in the left body of the lateral ventricle and the right cerebellum hemisphere were isointense on T1-weighted images (a and d), and hypointense on T2-weighted images (b and e). The lesions were enhanced after gadolinium-diethylenetriamine pentaacetate injection (c and f)
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F1
Magnetic resonance imaging (MRI) revealed intracranial mass lesions in the right hemisphere of the cerebellum and the left body of the lateral ventricle [Figure 1].
Two weeks following hospital admission, the right cerebellum lesion almost disappeared (a). Two weeks later, new enhanced lesions emerged in the choroid plexus of the fourth ventricle (b). Enlarged image of the left body of the lateral ventricle lesion (c)
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F2
Two weeks later, the right cerebellar lesion disappeared [Figure 2a]; however, after 2 more weeks, the lateral ventricular lesion was enlarged and new mass lesions developed in the choroid plexus of the fourth ventricle [Figure 2b and c].
Intraoperative neuroendoscopic image showed irregular surface in the lateral ventricle. Many small particles were floating in the cerebrospinal fluid, which was suggestive of leptomeningeal dissemination
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F3
A neuroendoscopic biopsy was performed on the lesion of the left body of the lateral ventricle [Figure 3].
Pathological findings: Original magnification x20 (a), x40 (b). H and E staining revealed epithelioid granulomatous inflammation
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F4
The histopathology studies revealed epithelioid granulomatous inflammation and large numbers of lymphocytes and plasma cells infiltrating perivascular spaces [Figure 4].
(a-c) After steroid pulse treatment, the lesions almost disappeared
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F5
Methylprednisolone (1000 mg/day) was administered for 3 days, and the intracranial lesions almost disappeared [Figure 5].
(a-c) After 12 months, all the lesions had resolved and had not recurred
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F6
No exacerbations or recurrences were found even up to a year later [Figure 6].