PMC4821140_01
Clinical course of the patient. In the clinical course, brain attack had been suspected three times by the findings of MRI T2WI on hospital days 1, 44 and 79. The patient deceased on hospital day 123. JCS = Japan Coma Scale.
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F1
The brain magnetic resonance imaging (MRI) showed multiple ischemic lesions including in the left temporal-parietal region and bilateral cerebellum which were hyperintense on T2-weighted imaging (T2WI; fig. 1). MRI T2WI showed a new ischemic lesion in the left anterior region (fig. 1). Scale 3) and incomplete paralysis on the left side of her body was found on hospital day 79, and MRI T2WI on hospital day 94 showed new ischemic lesions in the right anterior region of the cerebrum (fig. 1). Subsequently, we found suspected ischemic lesions expanded by CT scan and her general condition gradually deteriorated; however, we could not understand their cause.
Histopathological images of the brain. a Macroscopic view of the specimen. Tumors are confirmed as red color lesion. b Lymphoma cell invasion is confirmed inside the vessel of the vein (red arrow). Hematoxylin and eosin staining (x200). c The immunohistochemical study of lymphoma cell is positive for CD20 (x200).
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F2
First, tumor embolism caused by atypical lymphoid cells was confirmed in vessels of brain, lung, and liver, namely dissemination to solid organs (fig. 2a, b). Second, tumors in the vessels were found to be B-cell lymphoma according to the morphology and immunophenotype (CD20+; fig. 2c).