PMC5993354_01
Representative photos of the patient's excisional biopsy of a left inguinal lymph node. A) Hematoxylin and eosin stain showing diffuse large B-cell lymphoma. B) Immunohistochemistry showing Ki-67 index greater than 95%.
gr1.jpg
PMC5993354_01_gr1.jpg
f0005
He subsequently underwent an excisional biopsy of a left inguinal lymph node, which revealed DLBCL not otherwise specified (Fig. 1A). The Ki-67 index was greater than 95% (Fig. 1B).
Computerized tomography and positron emission tomography (CT-PET) scan from skull base to mid-thigh, coronal view. A) Staging CT-PET scan noted right axillary, splenic, and retroperitoneal adenopathy (white arrows) with intense fluorodeoxyglucose uptake. The maximum standardized uptake value was 26. B) CT-PET scan after completion of six cycles of R-CHOP revealed marked reduction in lymphadenopathy and associated hypermetabolic disease, though with a persistent small focus of hypermetabolic activity at the splenic hilum (white arrow) with a standardized uptake value of 11.5. C) Surveillance CT-PET scan three months after completion of consolidative radiotherapy displayed significant interval lymphadenopathy, with multiple, new, fluorodeoxyglucose-avid mediastinal, peri-hilar, peri-portal, and retroperitoneal lymph nodes (white arrows) with standardized uptake values ranging from 12.6 to 25.
gr2.jpg
PMC5993354_01_gr2.jpg
f0010
A CT-PET scan showed hypermetabolic axillary, splenic, and retroperitoneal adenopathy with standardized uptake values (SUV) ranging between 25 and 30 (Fig. 2A). There was, however, continued hypermetabolic activity involving the splenic hilum corresponding with an SUV of 11.5 (Fig. 2B). Three months later, a repeat CT-PET scan showed multiple enlarged FDG-avid lymph nodes above and below the diaphragm with an SUV range from 12.6 to 25 (Fig. 2C).
Representative images of the patient's supraclavicular lymph node biopsy. A) Hematoxylin and eosin showing non-necrotizing granulomas. Immunohistochemical staining for CD3 (B) highlights small T cells (brown) and for CD19 (C) which was negative, without any B cells present.
gr3.jpg
PMC5993354_01_gr3.jpg
f0015
He additionally underwent a core needle biopsy of a right supraclavicular lymph node which also revealed granulomatous lymphadenitis with nearly complete replacement of normal lymph node architecture with non-caseating granuloma and no evidence of recurrent lymphoma, and with findings clearly favoring sarcoidosis (Fig. 3, A-C).