Figure MRI and neuropathologic characteristics of the tumefactive demyelinating lesion in our patient MRI and neuropathologic characteristics of the tumefactive.

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Presentation transcript:

Figure MRI and neuropathologic characteristics of the tumefactive demyelinating lesion in our patient MRI and neuropathologic characteristics of the tumefactive demyelinating lesion in our patient T1-weighted imaging revealed a nodular and linear enhancement with gadolinium in the center of the lesion (A and B). FLAIR imaging revealed an extensive hemispheric white matter lesion with a mass effect in the left fronto-parieto-temporal lobe (C and D). The high-intensity lesion observed on FLAIR images appeared as a lesion of slightly lower signal intensity on diffusion-weighted images (E) and exhibited an increased apparent diffusion coefficient value (F), suggestive of vasogenic edema. An existing periventricular lesion was detected in the right posterior ventricular horn without gadolinium enhancement (A, C, arrow). FLAIR imaging of the brain (G) and T2-weighted imaging of the cervical cord (H) before TDL development showed typical MS lesions (arrow indicates a cervical lesion). We performed a biopsy of the enhanced lesion. Parenchymal inflammatory infiltrates were invariably present and were accompanied by foamy macrophages and reactive astrocytes (I). Perivascular lymphocytic cuffing and Creutzfeldt-Peters cells (inset) were also observed (hematoxylin and eosin stain, scale bar = 300 μm, inset scale bar = 25 μm) (J). Demyelination was observed as a loss of Luxol fast blue staining (Klüver-Barrera stain, scale bar = 200 μm) (K). Relative axonal preservation (IHC stain for neurofilaments, scale bar = 200 μm) (L). Extensive macrophage infiltration presenting with lipid-laden foamy macrophages (IHC for CD68, scale bar = 200 μm) (M). Relative glial fibrillary acidic protein preservation within the TDL (IHC for GFAP scale bar = 200 μm) (N). Continuous sections of the perivascular lymphocytic cuffing lesion (O: IHC for CD3; P: IHC for CD8; Q: IHC for CD4; R: IHC for CD20, scale bar = 200 μm). Inflammatory infiltrates were composed of lymphocytes (O), most of which were CD8-positive cytotoxic T lymphocytes (P). Scattered CD4-positive helper T cells (Q) and relatively fewer B cells were observed (R). CD4-positive T lymphocytes tended to accumulate predominantly in the parenchymal tissue (Q). FLAIR = fluid-attenuated inversion recovery; IHC = immunohistochemical; TDL = tumefactive demyelinating lesion. Kazumasa Okada et al. Neurol Neuroimmunol Neuroinflamm 2018;5:e484 Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.