case_images: PMC11090529_01
case_images: (a) T1-weighted axial-enhanced magnetic resonance imaging sequence, a periventricular lesion is observed on the left lateral ventricle with extension to the white matter of the parietal lobe, the right lateral ventricle is observed without alterations. (b) Two well-defined lesions are observed at the level of the ventricular atrium, and a slightly heterogeneous center is observed. (c) Moderate perilesional edema was observed on the T2 sequence with predominance in the left lesion and with an evident hypointense center. No communication of both lesions through the corpus callosum was identified.
case_images: SNI-15-143-g001.jpg
case_images: PMC11090529_01_SNI-15-143-g001.jpg
case_images: F1
case_images: A simple and contrasted tomography was performed, showing the presence of two lesions at the level of both ventricular trigone each one apparently, which were confirmed by magnetic resonance imaging (MRI) scan indicating periventricular lesions with extension to the white matter of the temporal and parietal lobes, a clear reduction of the ventricular space of both atrium was observed, no communication between these lesions through fibers of the corpus callosum, with mostly uniform enhancement at gadolinium contrast [Figure 1], and restriction to diffusion.
case_images: A T1-weighted gadolinium-enhanced magnetic resonance imaging spectroscopy with voxel within the enhancement center of the lesion, at the level of the left ventricular atrium, with the signal of an elevated choline peak, as well as creatine and a reduced N-acetyl aspartate peak. There is an elevated choline/creatine ratio of 2.27 and elevated lipids/lactate consistent with areas of necrosis.
case_images: SNI-15-143-g002.jpg
case_images: PMC11090529_01_SNI-15-143-g002.jpg
case_images: F2
case_images: Subsequently, a spectroscopy study was performed [Figure 2] 8 days before treatment with dexamethasone, where peaks of choline and creatine were observed, a high choline/creatine (Cho/Cr) ratio, with peaks of lipids and lactate, as well as a decrease in N-acetyl aspartate (NAA), suggestive of malignancy and presence of areas of necrosis.
case_images: (a) Diffuse proliferation of mature lymphocytes infiltrating the brain tissue is observed. (b) Typical angiocentric arrangement. (c) Intense positive immunoreaction for CD20 in the membrane and cytoplasm. (d) Positive immunochemical expression for Ki-67:70%, related to a high proliferation index.
case_images: SNI-15-143-g003.jpg
case_images: PMC11090529_01_SNI-15-143-g003.jpg
case_images: F3