case_images: PMC7642366_01
case_images: (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.
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case_images: F1
case_images: 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.
case_images: (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).
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case_images: PMC7642366_01_fneur-11-571576-g0002.jpg
case_images: F2
case_images: 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).
case_images: 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).
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case_images: PMC7642366_01_fneur-11-571576-g0003.jpg
case_images: F3
case_images: 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).
case_images: Timeline with relevant data from the episode of the case.
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case_images: PMC7642366_01_fneur-11-571576-g0004.jpg
case_images: F4
case_images: Overall, the patient was satisfied with the current treatment effect, but was still worried about the resistance of TKI (Figure 4).