PMC5367597_01
Abdominal CT findings. A CT scan showing diffuse hypodense enlargement of the pancreatic head (arrow).. Notes: (A-B) unenhanced and (C-D) arterial phase.. Abbreviation: CT, computed tomography.
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Abdominal computed tomography (CT) showed an irregular enlargement of the pancreas and a 3.0x3.5 cm heterogeneous enhanced mass arising from the pancreatic head (Figure 1).
A gross pathological examination revealed a 3.0 x 4.0 cm multiseptated mass in the pancreatic head (arrow). The cut surface of the tumor was yellowish (arrow).
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The cut surface of the tumor was yellowish (Figure 2).
Histopathology showed small tumor cells without cell adhesion or tissue structure proliferation (A), and HE immunochemical staining was positive for B-cell markers CD20 and CD79a (B, C), compatible with the diagnosis of diffuse large B-cell non-Hodgkin lymphoma. HE immunochemical staining confirmed a proliferative index of over 50-60% (D). (A-C x400; D x200).. Abbreviation: HE, hematoxylin and eosin.
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A histological report confirmed diffuse large B-cell lymphoma (Figure 3A). Immunohistochemical staining showed the cells to be positive for CD20 and CD79a (Figure 3B and C) and negative for CD3, CD10, and BCL-2. The histology also confirmed a proliferative index of over 50%-60% (Figure 3D).
A PET-CT did not detect any signs of disease recurrence after 16 months.. Notes: A and B represent different planes on PET-CT.. Abbreviations: R, right; L, left; PET-CT, positron emission tomography-computed tomography.
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The last positron emission tomography-CT did not detect any signs of disease recurrence (Figure 4).
PMC5367597_02
(A, B) A CT scan showing diffuse hypodense enlargement of the pancreatic tail (arrow).
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The mass was heterogeneous, with no clear boundary between lesions, spleen, stomach, and pancreas, nearby blood vessels were wrapped around it, and there were multiple enlarged lymph nodes in the abdominal cavity (Figure 5A and B).
Pathological findings. (A) HE shows irregularly-shaped, atypical lymphocyte infiltration (x40). (B) CD20 positive atypical lymphocytic cells (x400). (C) A high Ki-67 proliferation index (80%; x200).. Abbreviation: HE, hematoxylin and eosin.
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The pathological evaluation of the CT-guided biopsy revealed that the tumor was CD20-positive (Figure 6B) and CD3- and pancytokeratin-negative, with a high Ki-67 proliferation index (80%) (Figure 6C), and findings are consistent with diffuse large B-cell lymphoma (Figure 6A).
Lesions were significantly reduced after 2 cycles of CHOP chemotherapy regimen (A, B). After 4 cycles of CHOP chemotherapy regimen (C, D).
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The size of the tumor was significantly reduced after four cycles of the CHOP chemotherapy regimen (Figure 7), and further follow-up is being carried out.