PMC9949603_01
Horizontal sections of computed tomography (CT) of the upper abdomen. (A) A horizontal section of the upper abdomen performed at the presentation of paralysis of the lower extremity. (B) A CT performed 2 months after the first CT presenting with a syncopal episode demonstrates a remarkably enlarged and ruptured spleen with intraperitoneal hemorrhage.
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The volume of the spleen was shown to be more than two times compared with that observed in the CT performed 2 months before (Fig. 1).
The pathological examinations of the extracted spleen. (A) Gross anatomical examinations show infarcted areas (white) and multiple nodules. The size of the spleen was 15 x 10 x 8 cm3 in diameter. (B) Histological examinations with hematoxylin and eosin staining show diffuse invasion of large lymphoma cells with large and irregular-shaped nuclei. (C), (D) Staining of CD20 and Ki67, respectively. Scale bars depict 100 mum.
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The extracted spleen was enlarged with diameters of 15 x 10 x 8 cm3 (Fig. 2A). Histological examinations reported on the 24th admission day showed diffuse proliferation of atypical lymphocytes with large irregular nuclei, which was consistent with DLBCL (Fig. 2B). The immunohistochemical staining of the spleen was positive for CD20, CD10, CD79a, and Bcl-6; partially positive for Ki-67 (70%-80%); and negative for EBV-ISH, CD3, CD5, and Bcl-2 (Fig. 2C, D).
Autopsy results of the liver and the spinal cord. (A) The cross section of the liver shows multiple white nodules indicating invasions of lymphoma cells in parenchyma and portal veins. (B) A histological examination revealed diffuse invasions of lymphoma cells as seen in the spleen. Scale bars depict 100 mum. (C) A transverse section with hematoxylin and eosin staining. Note that the vacuoles and demyelization occurred but no apparent invasion of lymphoma cells is seen. (D) CD68 staining. Diffuse invasion of histiocytes can be seen.
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An autopsy revealed: (1) DLBCL of the spleen with invasion to multiple organs and systemic lymph nodes, including the cervical, pulmonary hilum, para-aortic, peripancreatic nodes, the bone marrow, liver, both lungs, heart, and bilateral adrenal glands; additionally, effusion into the body cavities were found. (2) All lymph nodes obtained from the neck, lung, para-abdominal aorta, and abdominal cavity showed invasions of large lymphoma cells that were identical with those found in the spleen. (3) The liver was significantly enlarged, weighing 2,750 g, with numerous white nodules of DLBCL in its parenchyma, invasive to the portal area, especially showing massive invasion to the portal vein (Fig. 3A, B). (4) Hemophagocytic syndrome in the bone marrow was remarkable. (5) Macular incomplete necrosis in and CD68-positive histiocytic infiltration to both white and gray matters of the spinal cord from cervical to sacral were seen (Fig. 3C, D).