PMC4435375_01
(A) Axial and (B) coronal view of abdominal CT showing collapsed, thickened gallbladder wall with pericholecystic fluid (yellow arrow).
crj-02-110-g001.jpg
PMC4435375_01_crj-02-110-g001.jpg
F1
Abdominal computed tomography showed a collapsed, thickened gallbladder wall with pericholecystic fluid without gallstones, intra-abdominal free air, or intra-abdominal lymphadenopathy (Figure 1).
(A) H&E stain of the bone marrow biopsy showed severely hypocellular marrow and relatively increased interstitial small to medium-sized lymphoid cells. Immunohistochemistry of the biopsy confirmed diffuse large B-cell lymphoma with (B) positive CD20 and (C) positive Ki67.
crj-02-110-g002.jpg
PMC4435375_01_crj-02-110-g002.jpg
F2
Immunohistochemistry found CD 20+, CD 138-, CD10+/-, BCL6+/-, MUM1+/-, CD5-, EBER-, Cyclin D1-, BCL2+, CD43-, ISH lambda+/-, kappa-, Ki67+, CD23-, and CD3-, diagnostic of B-cell non-Hodgkin lymphoma, mixed small and large cells (Figure 2).
(A) H&E stain of the gallbladder biopsy showed atypical medium lymphoid cell infiltrate along mucosa. Immunohistochemistry of the biopsy confirmed diffuse large B-cell lymphoma with (B) positive CD20 and (C) positive Ki67.
crj-02-110-g003.jpg
PMC4435375_01_crj-02-110-g003.jpg
F3
The gallbladder specimen was re-examined with immunohistochemistry and was and found to be CD20+, ISH lambda+/-, kappa-, CD138-, CD10-, BCL6+, MUM1+, BCL2-/+, Tdt-, CD34-, cyclinD1-, c-Myc-, EBER-, Ki67+, and CD3-, consistent with stage IV diffuse large B-cell lymphoma (DLBCL) with gallbladder involvement (Figure 3).