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