PMC8606549_01
PET/CT scans of the patient. (A) Baseline. The fluorodeoxyglucose (FDG) uptakes increased in multiple patchy shadows and massive consolidations of the bilateral lungs (SUVmax = 22.1), multiple partial bones (SUVmax = 19), multiple swelling lumbosacral nerve roots (SUVmax = 16), masses in the bilateral adrenal glands (SUVmax = 31.2), and a nodule (0.7 cm) between cervical rear muscles. (B) Disease progression after first-line chemotherapy. The sizes and FDG uptakes of massive consolidations in the bilateral lungs increased with SUVmax of 31.5. FDG uptakes of other lesions decreased. (C) The patient achieved a complete response after four cycles of sitilimab and chidamide. The SUVmax of lesions in the left and right lungs were 2.4 and 2.1, which indicated a Deauville score of 2.
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The PET/CT re-examination ( Figure 1A ) revealed increased FDG uptakes in multiple patchy shadows and massive consolidations in the bilateral lung, bilateral adrenal glands, multiple bones, and lumbosacral nerve roots. However, after four cycles of treatment, an interim PET/CT scan ( Figure 1B ) revealed that the sizes and FDG uptakes of the pulmonary and mediastinal lesions progressed (SUVmax = 31.5), with significantly reduced sizes of the other lesions. After four cycles of combination treatment, a PET/CT scan ( Figure 1C ) showed that the patient was considered to be in complete metabolic remission according to the 2014 Lugano criteria.
Pathological analysis. (A) Pulmonary histopathology at disease progression, which was consistent with diffused large B cell lymphoma, x200 H&E. (B) The lymphoma cells were PD-L1 positive, x200.
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A repeat pathological analysis biopsy showed that the lymphoma was still DLBCL with PD-L1 expression ( Figure 2 ).