case_images: PMC9239761_01
case_images: Axial T2-weighted (a), axial FLAIR (b), and sagittal FLAIR (c) views of MRI brain showing CNS relapse. Images show T2 isointense-hypointense signal in right inferior temporal lobe with peripheral edema causing expansion of the uncus (yellow arrow) without mass effect on temporal horn of right lateral ventricle (blue arrow).
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case_images: PMC9239761_01_CRIHEM2022-7139661.001.jpg
case_images: fig1
case_images: A 23-year-old African-American male presented to our clinic following a diagnosis of relapsed CNS lymphoma (Figures 1 and 2).
case_images: Contrast-enhanced axial (a), coronal (b), and sagittal (c) views of MRI brain showing CNS relapse. Images reveal homogenous enhancement (blue arrows) in periventricular tissues of right temporal lobe.
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case_images: PMC9239761_01_CRIHEM2022-7139661.002.jpg
case_images: fig2
case_images: A 23-year-old African-American male presented to our clinic following a diagnosis of relapsed CNS lymphoma (Figures 1 and 2).
case_images: Parietal core brain biopsy of initial PCNSL mass. H and E stain showing neural tissue with infiltration of large round blue cells at 40x (a) and 100x (b). Positive CD20 stain highlighting the infiltration of large round blue cells at 100x (c). Positive MUM1 (d) and negative CD10 stains (e) supporting non-GCB subtype.
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case_images: PMC9239761_01_CRIHEM2022-7139661.003.jpg
case_images: fig3
case_images: The patient had a history of Wolff-Parkinson White syndrome (WPW) and PCNS-DLBCL (nongerminal center B-cell-like (non-GCB) subtype, Figure 3), and had previously been treated with HD-MTX-based induction chemotherapy and an autologous stem cell transplant (ASCT).
case_images: FNA and core biopsy of adrenal gland mass. H and E stain showing infiltration of large round blue cells and necrosis at 40x (a), 100x (b), 400x (c). CD20 stain highlight the infiltration of large round blue cells at 100x (d). Ki-67 stain showing a proliferation rate of >90% of the infiltration of large round blue cells at 100x (e).
case_images: CRIHEM2022-7139661.004.jpg
case_images: PMC9239761_01_CRIHEM2022-7139661.004.jpg
case_images: fig4
case_images: PAX5+ and CD20+ cells (Figure 4), consistent with systemic relapse from his initial CNS lymphoma. Positron emission and computed tomography (PET-CT) showed increased tracer uptake of bilateral adrenal glands with a small mass inferior to the right adrenal gland (Figure 5).
case_images: Pretreatment coronal maximum-intensity-projection (a) and axial fused FDG-PET (b) images show enlarged and hypermetabolic bilateral adrenal glands (blue arrows) with SUV max of 17.1 and 14.1 on the right and left respectively. Posttreatment coronal maximum-intensity-projection (c) and fused axial FDG-PET (d) images show resolution of previously seen hypermetabolic activity of bilateral adrenal glands two months following CAR-T.
case_images: CRIHEM2022-7139661.005.jpg
case_images: PMC9239761_01_CRIHEM2022-7139661.005.jpg
case_images: fig5
case_images: PAX5+ and CD20+ cells (Figure 4), consistent with systemic relapse from his initial CNS lymphoma. Positron emission and computed tomography (PET-CT) showed increased tracer uptake of bilateral adrenal glands with a small mass inferior to the right adrenal gland (Figure 5). The patient's hospital course was complicated by supraventricular tachycardia associated with WPW and grade 1 cytokine release syndrome on day +6, requiring supportive treatment. The patient achieved a complete metabolic response (CMR) on day +60 by PET-CT and MRI with a Deauville score of 3 (Figure 5).