PMC7642366_01
(A) Computed tomography (CT) scan at diagnosis demonstrating acute intracerebral hemorrhage (ICH) in the right frontal lobe. (B) CT scan demonstrating ICH re-occurrence at day 3 after the first craniotomy. (C) CT scan demonstrating rebleeding after the second craniotomy. (D-F) Magnetic resonance images showing multiple intracranial lesions (arrow) 1 month after the first craniotomy.
fneur-11-571576-g0001.jpg
PMC7642366_01_fneur-11-571576-g0001.jpg
F1
Computed tomography (CT) revealed a parenchymal hematoma about 74.8 ml in the right frontal lobe (according to the Tada formula), with peripheral cerebral edema and obvious middle-line shift (Figure 1A). Babinski's sign on the left was positive again, while repeated CT scans showed rebleeding in the surgical area with obvious middle-line shift (Figure 1B). The postoperative brain CT once more showed rebleeding in the operation area (Figure 1C). T1-weighted images (Figures 1D-F). The patient was asymptomatic, so he was discharged and asked to continue dasatinib treatment.
(A) Bone marrow smear (Wright-Giemsa, x 1,000) revealing active proliferation of granulocyte series, mainly metamyelocytes (blue arrow) and myelocytes (red arrow). (B) Cerebrospinal fluid smear (Wright-Giemsa, x 1,000) revealing abnormal granulocyte series, mainly metamyelocytes and (blue arrow) myelocytes (red arrow). (C) Chromosomal analysis revealing a Philadelphia translocation t(9;22)(q34;q11).
fneur-11-571576-g0002.jpg
PMC7642366_01_fneur-11-571576-g0002.jpg
F2
The BM smear showed an active proliferation of granulocytes, mainly metamyelocytes and myelocytes (Figure 2A). The chromosomal analysis identified a Philadelphia translocation t(9;22)(q34;q11) (Figure 2C), which confirmed the diagnosis of CML. The CSF smear also revealed abnormal granulocytes, mainly metamyelocytes and myelocytes, without blast cells (Figure 2B).
Photomicrographs of the resected brain tissue revealing myeloid cell hyperplasia with hemorrhage (hematoxylin and eosin stain A: x 100, B: x 400), and immunohistochemical staining demonstrating that tumor cells are positive for myeloperoxidase (C: x 400) and Ki-67(D: x 400).
fneur-11-571576-g0003.jpg
PMC7642366_01_fneur-11-571576-g0003.jpg
F3
Immunohistochemical staining demonstrated that the cell was positive for MPO and Ki-67(30%), suggesting the diagnosis of intracranial involvement of immature myeloid cells (Figure 3).
Timeline with relevant data from the episode of the case.
fneur-11-571576-g0004.jpg
PMC7642366_01_fneur-11-571576-g0004.jpg
F4
Overall, the patient was satisfied with the current treatment effect, but was still worried about the resistance of TKI (Figure 4).