PMC7771406_01
Axial fluid attenuation inversion recovery (FLAIR) (a) T2-weighted images (b) show a large cystic mass in the left frontoparietal region. Note incomplete suppression of fluid signal on FLAIR and mild perilesional edema and mass effect on the posterior horn of the left lateral ventricle. On post contrast image (c) there is complete rim enhancement and irregular, peripheral nodular enhancement in the anterior portion of the lesion. There is scalloping of the overlying bone cortex (arrow).
SNI-11-463-g001.jpg
PMC7771406_01_SNI-11-463-g001.jpg
F1
Subsequent contrast-enhanced magnetic resonance imaging study revealed a large cystic mass lesion measuring 7.0 x 3.8 cm (transaxial) in the left frontoparietal lobe, following cerebrospinal fluid signal intensity on T1- and T2-weighted images with incomplete suppression of fluid signal fluid attenuation inversion recovery (FLAIR) sequence and no diffusion restriction [Figure 1].
Decompression of the cyst with biopsy of the enhancing lesion was performed. Hematoxylin and eosin stained section (x20) of left temporal lobe showing perivascular granulomatous inflammation within unremarkable background brain parenchyma.
SNI-11-463-g002.jpg
PMC7771406_01_SNI-11-463-g002.jpg
F2
Histopathological analysis showed fragments of brain parenchyma with gliosis and prominent perivascular granulomatous inflammation with mixed picture of CD4 and CD8-positive cells [Figure 2].
(a) Subsequent chest CT and (b) whole-body 2-[18F]-fluoro-2deoxy-D-glucose-positron emission tomography showed mediastinal lymphadenopathy.
SNI-11-463-g003.jpg
PMC7771406_01_SNI-11-463-g003.jpg
F3
Further subsequent work-up including chest computed tomography and whole-body 2-[18F]-fluoro-2deoxy-Dglucose-positron emission tomography showed mediastinal and cervical lymphadenopathy [Figure 3].
Hematoxylin and eosin stained section (x10) of right level V cervical lymph node demonstrating non-necrotizing compact epithelioid granulomas.
SNI-11-463-g004.jpg
PMC7771406_01_SNI-11-463-g004.jpg
F4
Cervical lymph node biopsy again showed non-necrotizing granulomatous inflammation, consistent with sarcoidosis [Figure 4].