case_images: PMC7265466_01
case_images: The images a, b, and c correspond to the patient 1. The images d, e, and f correspond to the patient 2. In both cases, we can appreciate a single intra-axial lesion in the right frontal lobe, prominently hypointense in T1 sequences (a and d) and hyperintense in T2 sequences (b and e). It shows intense contrast enhancement with hypocaptant center of cystic/necrotic aspect and is surrounded by a large halo of edema with vasogenic characteristics (c and f).
case_images: SNI-11-122-g001.jpg
case_images: PMC7265466_01_SNI-11-122-g001.jpg
case_images: F1
case_images: After contrast administration, both lesions enhanced with a ring-like pattern [Figure 1].
case_images: The images a and b correspond to the patient 1. The images c, d, and e correspond to the patient 2. Diffusion-weighted image demonstrate a clear rim of restricted diffusion in its solid marginal components: periphery of the lesion evince hyperintensity on diffusion- weighted imaging (a and c) and very low values on apparent diffusion coefficient map (b and d). In the perfusion study of the patient 2 (e), the peripheral region of the lesion manifests a slight increase in relative cerebral blood volume about 1.6 respect to the healthy contralateral white matter.
case_images: SNI-11-122-g002.jpg
case_images: PMC7265466_01_SNI-11-122-g002.jpg
case_images: F2
case_images: There was restricted diffusion, and only in case 2, minor increment of relative blood volume on perfusion maps was evident (about 1.6 respect to the healthy contralateral white matter) [Figure 2].
case_images: PMC7265466_02
case_images: All images belong to the patient 1. These images correspond to the surgical site (a and b) and the tumor resection (c and d). We can appreciate strong red fluorescence under blue light illumination (OPMI/Pentero, Carl Zeiss, Oberkochen, Germany).
case_images: SNI-11-122-g003.jpg
case_images: PMC7265466_02_SNI-11-122-g003.jpg
case_images: F3
case_images: StealthStationTM S8 (Medtronic, Minneapolis, USA), and the area of 5-ALA fluorescence corresponds exactly with the gadolinium enhancement on MRI in both cases. Surgery was uneventfully carried on until 5-ALA-induced fluorescence was no longer evident [Figure 3].
case_images: Postoperative magnetic resonance image (contrast- enhanced T1-weighted images). Total resection of the tumor was achieved in the patient 1 (a). The patient 2 present milimetric remains in the surgical site (b).
case_images: SNI-11-122-g004.jpg
case_images: PMC7265466_02_SNI-11-122-g004.jpg
case_images: F4
case_images: Postoperative MRI confirmed total resection, presenting only milimetric remains in the surgical site in patient 2 [Figure 4].
case_images: All images belong to the patient 2. Paraffin section with immunoperoxidase technique x10. Neoplastic cells express CD20 (a), BCL2 (b), BCL6 (c), MUM1 (d), and MYC (e). Ki-67 proliferation index is high (f).
case_images: SNI-11-122-g005.jpg
case_images: PMC7265466_02_SNI-11-122-g005.jpg
case_images: F5
case_images: They showed diffuse lymphoid cell proliferation immunoreactive for B-cell marker but not for T-cell marker [Figure 5].