PMC6333083_01
F18-FDG PET and renal biopsy findings consistent with diffuse large B-cell lymphoma. A, Widespread abdominal organ involvement prior to therapy. B, Significant interval improvement in disease burden after two cycles of CHOP. C, Kidney mass biopsy showing lymphoid cells with large nuclei, irregular nuclear contours, prominent nucleoli, and modest amounts of cytoplasm (white arrow) with scattered forms containing very large, pleomorphic nuclei (black arrow) (hematoxylin and eosin stain, 100x). D, Tumor cells positive for CD79a (white arrow) (CD79a immunoperoxidase stain, 100x)
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There were scattered forms with very large, pleomorphic nuclei (hematoxylin and eosin stain, Figure 1C). The tumor cells were positive for CD79a, PAX5, CD19, CD22, OCT2, BCL-6, MYC, CD30, and CD45 (CD79a immunoperoxidase stain, Figure 1D). Further staging was performed as an outpatient, including F18-FDG PET scan, which showed intense FDG uptake in the anterior mediastinal mass, bilateral renal masses, pancreas, supraclavicular lymph nodes, middle mediastinal lymph nodes, bilateral adrenal glands, anterior left iliac bone, and the T6 vertebral body (Figure 1A). Arbor stage IVB disease with an International Prognostic Index of 3. As such, she was initiated on CHOP [cyclophosphamide (750 mg/m2, intravenous), doxorubicin (50 mg/m2, intravenous), vincristine (1.4 mg/m2, intravenous), and prednisone (100 mg/m2, oral)] with methotrexate (3.5 gm/m2, intravenous) included during odd cycles for CNS prophylaxis. A repeat F18-FDG PET scan after three cycles of CHOP showed marked interval improvement with reduction in size and FDG avidity of all previously demonstrated masses (Figure 1B).