case_images: PMC10623147_01
case_images: Pre-op MRI of the skull 2022 demonstrating the left anterior scalp lesion of 4.0 cm x 2.7 cm x 2.9 cm soft tissue scalp mass overlying the left frontal lobe size prior to resection. Post-op MRI of brain in 2022 showing normal curvature of the scalp after excision and a left parietal scalp postsurgical defect with mild associated enhancement, which is overall nonspecific. No abnormal parenchymal or meningeal enhancement.
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case_images: PMC10623147_01_fonc-13-1252512-g001.jpg
case_images: f1
case_images: The lesion enhanced, showed restricted diffusion, and had areas of susceptibility representing calcification and punctate hemorrhage possibly secondary to a recent biopsy ( Figure 1 ).
case_images: Image in the operating room of wound after the 4 x 4 cm lesion (right) was excised.
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case_images: f2
case_images: This excision left an approximate 4 cm diameter circular defect in the left anterior scalp with no bony defect ( Figure 2 ). The excision specimen was a 5.5 x 4.3 cm, unoriented skin with the underlying lesion ( Figure 2 ).
case_images: Microscopic image of the excised specimen showing dense neoplastic lymphocytic infiltration in the surround adnexal and perivascular regions and small to medium in size with irregular nuclear contour (A). (B-D) shows the presence of tumor markers CD20, TdT, and CD34 respectively. These are indicative of a B-LBL diagnosis.
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case_images: PMC10623147_01_fonc-13-1252512-g003.jpg
case_images: f3
case_images: CD10, CD19, CD22, CD34, CD99, TdT, and Bcl-2, and negative for Bcl-1, Bcl-6, cMYC, MUM-1, CD30, or P53. CD20 was partially positive in the neoplastic cells, ( Figure 3 ) and CD21 highlighted a residual follicular dendritic cell meshwork.
case_images: Image in 2023 of the anterior skull showing that the lesion was cured.
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case_images: PMC10623147_01_fonc-13-1252512-g004.jpg
case_images: f4
case_images: She has a few areas of alopecia; however, the appearance of the scalp overall is excellent given her preoperative appearance ( Figure 4 ).