Angiotropic Large Cell Lymphoma with Imaging Characteristics of CNS Vasculitis
Debbie K. Songa,
Nicholas M. Boulisa,
Paul E. McKeeverb and
Douglas J. Quintc
a Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, MI
b Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI
c Division of Neuroradiology, University of Michigan Medical Center, Ann Arbor, MI
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FIG 1. Images obtained on November 10, 1999.
Non-contrast-enhanced head CT depicts a wedge-shaped low-attenuation area (arrowhead) involving both the gray and white matter of the superficial anterior left parietal region most consistent with an ischemic focus.
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FIG 2. Images obtained on November 12, 1999.
A–E, Non-contrast-enhanced axial fluid-attenuated inversion recovery (10,002/105 [TR/TE]) (A and C), axial echo-planar diffusion-weighted (10,000/105) (B and D), and sagittal T2-weighted (3000/90) (E) head MR images depict multiple cortical and subcortical lesions. Most of these lesions are better seen on diffusion-weighted images and are therefore most consistent with areas of acute or subacute ischemic change (arrow). Note the lesion (arrowhead) in the splenium of the corpus callosum.
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FIG 3. Images obtained on November 17, 1999.
A and B, Repeat non-contrast-enhanced axial fluid-attenuated inversion recovery (10,002/105) head MR images disclose interval development of new areas of abnormal signal intensity in the right frontal region (arrowhead) and the genu of the corpus callosum (arrow) over 5 days. These findings are consistent with additional areas of ischemic change.
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FIG 4. Histologic specimens confirming ALCL.
A, Immunostaining with L26, a monoclonal antibody B cell marker, reveals large, atypical intravascular tumor cells occluding the lumen of a small cerebral blood vessel. Note the large ratio of vessel diameter to wall thickness, indicative of neoplastic lymphocytes occluding and distending the vessel lumen. In contrast to a true vasculitic process, the vessel wall itself does not show inflammatory damage.
B, Hematoxylin and eosin staining shows gray (black arrow) and white (white arrows) matter infarctions resulting from blood flow compromised by intravascular lymphoma.
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