case_images: PMC11000848_01
case_images: A: Computerized tomographic (CT) imaging of head without contrast showing right parietal lobe ill-defined mass with substantial surrounding vasogenic edema. B: Computerized tomographic (CT) imaging of head without contrast showing 7 mm leftward midline shift at the level of the septum pellucidum.
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case_images: HIV 1 viral load. Her computerized tomography (CT) of head without contrast (Fig. 1) showed right parietal lobe ill-defined mass with substantial surrounding vasogenic edema resulting in 7 mm leftward midline shift.
case_images: Magnetic resonance imaging (MRI) brain showing right parietal lobe, intra-axial mass with vasogenic edema and midline shift. (A) T2 weighted: demonstrates hyperintense lesion within the right parietal lobe with vasogenic edema and midline shift. Partial involvement of the posterior aspect of the corpus callosum(B) T1 weighted, pre-contrast: demonstrates hypointense lesion (C) T1 weighted post-contrast: demonstrates enhancing lesion (D) Diffusion weighted imaging (DWI): demonstrates minimal diffusion restriction.
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case_images: MRI brain with contrast (Fig. 2) showed heterogeneously enhancing horseshoe-shaped intra-axial lesion within the right parietal lobe resulting in vasogenic edema and midline shift towards left by 5.5 mm at the septum pellucidum with partial involvement of posterior aspect of corpus callosum.
case_images: Histopathology (A) H&E staining of brain biopsy in 20 X power demonstrates infiltrating lymphocytes in characteristic perivascular distribution "perivascular cuffing" perivascular cuffing (red arrowhead) and necrosis (blue arrowhead). (B) H & E staining of brain biopsy in 40X power demonstrates prominient nucleloi compatible with immunoblastic morphology (blue circle). (C) CD20 immunostaining of brain biopsy in 10X demonstrates predominant B lymphocytes in perivascular distribution (arrowhead). (D) CD3 immunostaining of brain biopsy in 10X demonstrates fewer T lymphocytes in perivascular cuff (blue circle). (E) Immunostaining of brain biopsy with Ki-67 in 10X demonstrates a high proliferation index in lymphocytes cells (arrowhead).
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case_images: The histopathology (Fig. 3) showed hypercellular brain tissue with atypical lymphoid proliferation showing angiocentricity and perivascular distributions.