MR imaging of multiple cerebral infarctions in angiotropic lymphoma (neoplastic angio-endotheliosis)

Abstract

A Japanese 58-year-old woman experienced sudden onset of dysarthria and gait disturbance. She gradually became disorientated and suffered progressive renal dysfunction. Renal failure and multiple organ failure progressed and she died four months after the onset of her symptoms.Brain magnetic resonance imaging revealed multiple lesions in the white matter of the brain and fewer lesions on the grey matter. The lesions were present not only in the cerebrum but also in the brain stem. On Tl-weighted images, they exhibited low signal intensity. On T2-weighted images, most of the lesions exhibited high signal intensity and the lesions in the right parieto-occipital cortex exhibited spotty low signal intensity because of haemorrhage ( Fig. 1 A, B). On Tl-weighted images after intravenous gadopentetate dimeglumine, the lesions in the right parieto-occipital cortex were enhanced and revealed high signal intensity ( Fig. 1 C).Postmortem histopathological study revealed widespread proliferation of pleomorphic cells with mitotic figures within the vessels of the central nervous system (CNS) (Fig. 1 D). Immunohistochemical studies showed that the neoplastic cells were positive for the leucocyte common antigen (LCA), and the B-cell marker, L-26. They were negative for T-cell markers, UCHL-1 and MT-1. The histopathological diagnosis was B-cell angiotropic lymphoma which presented as a form of neoplastic angio-endotheliosis. DiscussionTo our k n o w l e d g e , M R I studies of only four patients with N A E have been reported in the literature [3][4][5]. W h i l e there were multiple lesions in both the white and grey matter, they were p r e d o m i n a n t l y found in the white matter. On T 2 -w e i g h t e d images, the lesions s h o w e d high signal intensity, while on T1-w e i g h t e d i m a g e s they s h o w e d low signal intensity. In three o f the p r e v i o u s l y reported patients the affected *Keywords: Magnetic resonance imaging; cerebral infarction; neoplastic angioendotheliosis.