PMC5339518_01
Photomicrographs of the needle core biopsy of the conglomerate periaortic lymph node mass. (a) Neoplastic proliferation of large, atypical lymphocytes (hematoxylin and eosin). Immunohistochemical analysis showed that the neoplastic cells were (b) uniformly positive for CD20 but (c) negative for CD3 (staining observed on small reactive T-cells). (d) MYC was positive in 70-80% of cells. (e) BCL2 and (f) BCL6 were both uniformly positive. (g) Ki-67 was positive in greater than 95% of cells. Images were captured using a Leica DM1000 microscope with digital camera using the manufacturer's FireCam software (Leica Microsystems, Bannockburn, IL). Original magnification, 640x.
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Computed tomography (CT) revealed conglomerate lymph nodes (LNs) surrounding the abdominal aorta measuring 5 x 6 cm, suspicious for lymphoma (Figure 1(a)). The nuclear proliferative index (Ki-67) was markedly elevated (greater than 95%) (Figure 1). Approximately six months after his initial diagnosis, a follow-up CT measured the LNs at 1.7 x 1.4 cm and was notable for the absence of the previously visualized hypermetabolic periaortic mass on FDG-PET (Figures 1(d) and 1(e)).
Representative images from serial computed tomography (CT) and 18F-fluorodeoxyglucose- (FDG-) positron emission tomography (PET) scans showing resolution of the biopsy-proven aggressive B-cell non-Hodgkin lymphoma in a conglomeration of periaortic lymph nodes. (a) CT image prior to diagnosis. (b and c) CT and FDG-PET images (resp.) at time of diagnosis showing interval decrease in size of the mass. (d and e) CT and FDG-PET images (resp.) six months after initial diagnosis, showing resolution of the mass. Arrows denote the location of the mass.
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I disease (Figures 2(b) and 2(c)). Interestingly, the LN size had decreased from the prior CT to 2.5 x 2.5 cm.