PMC9393674_01
Clinical examination results. (A) Expression of AL cells at
diagnosis. (B) MRD in BM was negative after haplo-SCT when the
neurological symptoms appeared. (C) MRI demonstrated multiple
abnormal hyperintensity lesions surrounded by edema in
cerebellar vermis and left cerebellar hemisphere. (D and E) The
intracranial neoplasm was considered intracranial invasion of
leukemia by dynamic enhanced MRI. (F and G) The brain tissue
showed that diffuse infiltration of small round cells with deep
staining. (H) The tumor cells stained positive for CD19. (I) The
tumor cells stained positive for CD20. (J) The tumor cells
stained approximately 75% for Ki-67. (K) EBER in
situ hybridization was sparsely sparse positive.
MRD: minimal residual disease; BM: bone marrow; SCT: stem cell
transplantation; MRI: magnetic resonance imaging; EBER:
Epstein-Barr virus-encoded RNA; AL: all events; SSC-A: side
scatter-area.
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fig1-09636897221117532
The patient's leukemia cells expressed CD19+CD22+CD10+CD38+CD20- (Fig. 1A). After admission to our center, the patient was MRD-negative in the BM (Fig. 1B), and donor chimerism in the BM was at 100%. Magnetic resonance imaging (MRI) demonstrated multiple abnormal hyperintensity lesions surrounded by edema in the cerebellar vermis and the left cerebellar hemisphere (Fig. 1C). Dynamic enhanced MRI demonstrated intracranial neoplasm surrounded by edema in the cerebellar vermis and the left cerebellar hemisphere, which was considered to be an intracranial invasion of leukemia (Fig. 1D, E). The biopsy of the brain tissue showed diffuse infiltration of small round cells with deep staining (Fig. 1F, G). The tumor cells stained positive for CD19, CD20, Ki-67 (approximately 75%) (Fig. 1H-J), and C-myc (approximately 25%). Although the result of EBV-encoded RNA (EBER) in situ hybridization was sparsely positive (Fig. 1K), NGS of the brain tissue was positive for EBV.