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case_images: Cranial magnetic resonance imaging (MRI) findings prior to (left column) and after (right column) rituximab-containing chemotherapy. At presentation, MRI diffusion sequence (a) and coronal T2-FLAIR sequence (b) show hyperintense lesions in the periventricular withe matter (predominantly around right lateral ventricle). Follow-up MRI after completion of 2 courses of immunochemotherapy demonstrates marked regression of hyper-intensities (right column). Note Ommaya reservoir placed in right lateral ventricle (b, right column).
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case_images: Cranial magnetic resonance imaging (MRI) showed diffuse hyperintense lesions involving white matter around ventricles, without contrast enhancement (Figure 1[a]).
case_images: Computed tomography show pulmonary nodular lesions in middle and lower lobes.
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case_images: Two weeks later, respiratory symptoms worsened and a second CT revealed multiple pulmonary nodules in middle and lower fields, some of them with cavitation (Figure 2).
case_images: Histological examination of lung node biopsy reveals a dense lymphoid infiltrate with an angiocentric distribution, showing transmural infiltration (a). Immunohistochemistry reveals these cells express B-cell markers (MUM1 + [b]) and are strongly EBV-ISH positive (more than 50 high-power fields) (c). All these findings are consistent with LYG, grade III. Extensive T cell infiltration accompanying is also observed (CD3-positive cells [d]).. EBV: Epstein-Barr virus
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case_images: Biopsy of lung node showed a highly polymorphic infiltrate of large and atypical lymphoid cells, displaying an angiocentric and angiodestructive distribution (Figure 3[a]). T-cell proliferation (Figure 3[d]). These findings led to suspicion of T-cell lymphoma, but after later review, final diagnosis was LYG, grade III.
case_images: Cranial computed tomography reveals marked hydrocephalus and hipodensity around ventricles.
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case_images: Cranial CT scan revealed important hydrocephalus with worsening of previous findings (Figure 4).
case_images: Changes in EBV-DNA copies in cerebrospinal fluid (CSF) during clinical course of the patient, according to administration of courses of chemotherapy and rituximab.. EBV: Epstein-Barr virus
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case_images: EBV-DNA copies in CSF rapidly declined in the following weeks (Figure 5).