case_images: PMC10070256_01
case_images: Magnetic resonance imaging findings of the brain. Axial diffusion-weighted imaging (a-1 - a-2) and fluid-attenuated inversion recovery imaging (b-1 - b-2) obtained at admission reveal multiple hyperintense lesions bilaterally in the periventricular white matter, centrum semiovale, and corpus callosum. T1-weighted imaging (c-1 - c-2) acquired after injection of gadolinium contrast medium shows no enhancement of the lesions.
case_images: SNI-14-89-g001.jpg
case_images: PMC10070256_01_SNI-14-89-g001.jpg
case_images: F1
case_images: The lesions showed no enhancement on T1-weighted imaging following administration of gadolinium [Figure 1].
case_images: Axial computed tomography (CT) of the chest (a-1 - a-3) shows faint diffuse ground glass opacities in the upper and middle lung fields bilaterally. 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) (b-1 - b-3) reveals slightly diffuse FDG uptake in the upper and middle lung fields bilaterally without uptake by lymph nodes. CT of the abdomen (c) demonstrates diffuse enlargement of both kidneys without lymph node swelling. FDG-PET (d) shows remarkably high FDG uptake in both kidneys.
case_images: SNI-14-89-g002.jpg
case_images: PMC10070256_01_SNI-14-89-g002.jpg
case_images: F2
case_images: There was diffuse FDG uptake in both the upper and middle lungs without uptake by lymph nodes and remarkably high FDG uptake in the bilateral kidneys, suggesting a malignant hematological disease [Figure 2].
case_images: Histopathology of the resected lesion by random skin biopsy. Pathologic specimen (a and b) shows occlusion of small vessels by neoplastic cells with prominent nucleoli within subcutaneous adipose tissue. Tumor cells show positive staining for CD20 (c) and negative staining for CD3 (d). Magnification: (a) x200; (b-d) x400. Scale bars, 100 mum.
case_images: SNI-14-89-g003.jpg
case_images: PMC10070256_01_SNI-14-89-g003.jpg
case_images: F3
case_images: The bone marrow puncture contained no neoplastic cells, but the pathologic specimen obtained by skin biopsy showed occlusion of small vessels by neoplastic cells with prominent nucleoli inside the subcutaneous adipose tissue [Figures 3a and b]. Immunohistochemical examination revealed cluster of differentiation (CD) 79a (+), CD20 (+) and CD3 (-), suggesting multiorgan infiltration of B lymphohematopoietic system tumors [Figures 3c and d].
case_images: Brain magnetic resonance imaging (MRI) findings at 1 month after admission. The multiple high-intensity lesions apparent on MRI obtained at admission have decreased on diffusion-weighted imaging (a-1 - a-2), and no new lesions are identified on fluid-attenuated inversion recovery imaging (b-1 - b-2) and gadolinium-enhanced T1-weighted imaging (c-1 - c-2).
case_images: SNI-14-89-g004.jpg
case_images: PMC10070256_01_SNI-14-89-g004.jpg
case_images: F4
case_images: At 1 month after admission, follow-up neuroimaging showed no signs of recurrence [Figure 4], no epileptic discharges were seen on EEG, and her MMSE score had improved to 27/30.
case_images: Whole body computed tomography (a-1 - a-3 and c) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (b-1 - b-3 and d) obtained after three cycles of chemotherapy show complete disappearance of the abnormal signs and FDG accumulation identified on admission, indicating achievement of complete remission.
case_images: SNI-14-89-g005.jpg
case_images: PMC10070256_01_SNI-14-89-g005.jpg
case_images: F5
case_images: After three cycles of R-CHOP in combination with intrathecal methotrexate injection, the patient's serum LDH, CRP, and LDH, and CSF beta2-MG levels normalized; and there was complete disappearance of the FDG accumulation in the lung and kidney on FDG-PET [Figure 5], and the patient achieved complete metabolic remission.