PMC9674505_01
Brain MRI of the first admission revealed acute pontine infarction with high signal intensity on DWI (A) and hypointensity on apparent diffusion coefficient map (B) (yellow arrows); Repeat brain MRI of the second admission showed multifocal cerebral infarcts located at the left frontal lobe and bilateral corona radiata (C and D, white arrows).
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Abdominopelvic CT scan and brain MRI were obtained showing hepatomegaly, splenomegaly and subacute bilateral pontine infarction (Fig. 1). Brain MRI showed multifocal cerebral infarcts located at left frontal lobe and bilateral corona radiata (Fig. 1).
MRA of the brain revealed unremarkable intracranial vasculature (A); HR-vw MRI post-contrast T1W showed vessel wall thickening with moderate enhancement of bilateral MCA segments relevant to the cerebral infarction suggesting vasculitis (B) (yellow arrows).
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Intracranial high resolution vessel wall magnetic resonance imaging (HR-vwMRI) post-contrast T1W showed vessel wall thickening with moderate enhancement at the left PCA and bilateral MCA segments relevant to the cerebral infarction suggesting vasculitis (Fig. 2).
An abdominopelvic and thoracic CT scan revealed splenomegaly (A, red arrows); multiple liver lesions (B, yellow arrows); multiple bilateral small nodules of the lung (C, green arrows); multiple bilateral renal masses (D, white arrows).
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An abdominal, pelvic and thoracic CT-Scan revealed splenomegaly, multiple bilateral small nodules of the lung, multiple liver lesions, multiple bilateral renal masses, gastric wall thickening and multiple nodules in the omentum (Fig. 3).
The pathological findings of gastric biopsy revealed large B cell lymphoma. Diffuse infiltration of large lymphoid cells with prominent nucleoli and brisk mitosis (A, H&E stain, magnification x200). The tumor cells showed strong expression of CD20 (B, immunohistochemical stain, magnification x400).
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The pathological findings of gastric tissue biopsy revealed large B cell lymphoma (Fig. 4).