Case 359 -- A teenager boy with a brain mass

Contributed by Raj Hari, MD
Published on line in August 2003


The patient is a teenager boy who was previously diagnosed with ALL in 2001. He had numerous relapses and received a bone marrow transplant in 2002. He subsequently developed grafts vs host disease and his immunosuppression increased. The patient subsequently presented with visual disturbances and headache over a period of two to three weeks in May 2003. Initially, CT showed a large mass in the in the right temporal lobe. All other radiology was negative. A stereotactic brain biopsy was performed.


Figure 1. CT of brain: Shows a lesion of the right temporal lobe with mass effect compressing the lateral ventricle and basal ganglia.


Figure 2  H&E shows large pleomorphic cells with brisk mitotic activity.
Figure 3  H&E section shows vascular invasion of same large lymphocytes.


Figure 4  CD20, a B lymphocyte is positive in large B cells
Figure 5  CD3, a T lymphocyte marker is positive in small lymphocytes
Figure 6  Kappa is strongly positive
Figure 7  Lambda shows focal positivity
Figure 8  TDT, an ALL marker, is negative in large cells
Figure 9  EBER, an EBV marker in most PTLD, is positive in large B cells


Case IndexCME Case StudiesFeedbackHome