case_images: PMC11821657_01
case_images: Brain MRI of the patient. Multiple patchy long T2 signals were seen in the cortex, subcortex and white matter of the right frontal lobe of the left occipital lobe (A). On FLAIR sequence, multiple punctate and patchy high signals were seen in the cortex, subcortex and white matter of the bilateral frontal, parietal and occipital lobes (B, C). Cerebellar vermis punctate, left parietal lobe linear high signal on DWI; b = 1,000 (D, E). Multiple low signals were found in the left frontal lobe, parietal lobe and right occipital lobe on SWI (F). Linear enhancement signals were seen in the pia mater, left occipital lobe, right frontal lobe, bilateral parietal lobe, cortex and subcortex (G, H), and circular enhancement signals were seen in the sagittal subcortex and white matter (I).
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case_images: CNSV was considered ( Figure 1 ).
case_images: PET-CT showed decreased cortical metabolism in the right frontal lobe, parietal lobe, occipital lobe and left temporal lobe (A-D).
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case_images: No abnormalities or signs of tumors were found throughout the body ( Figure 2 ).
case_images: Pathological biopsy of occipital lobe of brain. H&E stain in our patient showed Multiple deep stained cell aggregation in blood vessels and partly outside the blood vessels on light microscope (A), adjusted to 800x, many round and darkly stained cells were found to aggregate (B).
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case_images: The histopathological biopsy revealed multiple tumor-like cell aggregations in the artery ( Figure 3 ), and immunohistochemistry showed positive results for CD19, CD20, CD34, Pax-5, Bcl-2, Bcl-6, Mum-1, Ki-67.
case_images: Occipital lobe immunohistochemistry of the patient, stained tumor cells gathered in the blood vessels. Occipital cortical artery positive for CD20 (A), occipital cortical artery positive for CD19 (B), occipital cortical artery partially positive for Bcl-2 (C), occipital cortical artery positive for Ki-67,proliferation index 60% (D), occipital cortical artery positive for Bcl-6 (E), occipital cortical artery positive for Mum-1 (F), occipital cortical artery positive for CD34 (G), occipital cortical artery positive for Pax-5 (H).
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case_images: These findings support a diagnosis of large B-cell lymphoma, classified as non-GCB according to Hans classification ( Figure 4 ).