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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | Sentinel & Steroid Rx Lesions | 3A0 Case 3 History
Case 3 History ---- The patient was a 66-year-old woman with a prior history of hypertension and diabetic peripheral neuropathy, who presented with unsteady gait, left hemiparesis, drooping of the mouth, and difficulty talking and imbalance. The patient's neurologist thought that the patient may have had MS over the past 2-3 decades. An MRI performed showed an abnormal enhancing lesion in the right inferior thalamus and right cerebral peduncle, as well as more widespread white matter abnormalities on T2 and FLAIR images. The patient received high-dose steroids for one week which was stopped two days before surgery. CSF flow cytometry demonstrated a predominant population of small T-cells, a small number of polytypic/reactive B-cells, and a minute population of clonal (lambda-restricted) CD10-positive, CD20-positive large B-cells. An Inflammatory process was the favored diagnosis. The initial biopsy (October) performed at an outside institution suggested a differential diagnosis of an inflammatory process including demyelinating disease, glioma, lymphoma, a sentinel lesion of lymphoma or possible vasculitis. The first biopsy material was sent to us for a second review and, with the second biopsy performed shortly thereafter (within two months) showing a diffuse large B-cell lymphoma, the first biopsy was designated a "sentinel lesion".
