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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, Intravascular | 14A0 Case 14 History
Case 14 History ---- The patient was a 78 year old woman who presented with multiple ischemic strokes and progressive cognitive decline. Her past medical history is significant for dyslipidemia and atrial fibrillation during a recent hospitalization. There was no history of systemic malignancy. Operative procedure: Left craniotomy for open biopsy. ---- Sections from the "left cerebellar cortex" show small to intermediate sized leptomeningeal and superficial cortical blood vessels are filled with discohesive malignant cells with scant cytoplasm and numerous mitoses which are positive for the B cell marker CD20. CD3 highlights scattered background mature-appearing T-cell lymphocytes. In situ hybridization is negative for EBV-encoded RNA (EBER). The malignant cells occlude most of the involved blood vessels, but appear to be largely confined to the intravascular spaces and do not infiltrate brain parenchyma, established by CD34 immunohistochemistry. The cerebellar cortex otherwise shows several foci of microinfarctions at different stages of resolution. There is eosinophilic neuronal necrosis of the Purkinje cells and patchy Bergmann astrocytosis.
