Sagittal slice containing the largest lesion that they want to biopsy.
I finally mustered the courage to look at the MRIs, before I didn’t want to, I am no radiologist, and I couldn’t think of anything positive coming from this. To discuss the biopsy I wanted to see them, to understand where they would access it and plan their biopsy. I had been working on stereotactic neurosurgery in the Maastricht University Medical Center before I came to Nijmegen in 2012, so I had a good understanding of the procedure (at least about the techniques behind it).
The MRIs indeed showed a big (3.5cm) lesion in the cerebellum. This lesion showed no necrosis in the center (necrosis is a bad sign) and had a well-defined border (ill-defined margins are extra bad). The location of the lesion wasn’t difficult to access with the biopsy needle (a 3.5mm diameter needle), but the location in the cerebellum, made it that risks such as a bleeding or brain swelling could quickly escalate to a coma or death. Nonetheless, the risks were low, estimated to be about 1% for these adverse events.
After this talk me and Adrienne spoke to the neurologist and the hematologist. According to the young hematologist, the cancer type they suspected (primary central nervous system lymphoma) is incredibly rare. The fact that my symptoms were getting less baffled her, she told us that this normally does not happen. Also, the neurologist seemed to be surprised with the state I was in and even mentioned that MS, however unlikely, was not off the table.