PMC9529637_01
(A) Axial view of the computed tomography image of the abdomen showing splenic infarction (identified with red arrow). (B) Coronal view of the computed tomography image of the abdomen showing multiple splenic infarcts (identified with red arrows).
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Contrast CT scan of the chest, abdomen and pelvis revealed multiple acute splenic infarcts (Fig. 1).
Histopathological slides of the needle core biopsy of liver. (A) Hematoxylin & Eosin stain (Magnification: 100x) showing abnormal large lymphoid cells in the liver sinusoids (arrow). Mitoses are present (arrowhead). The cells are large and pleomorphic with variably prominent nucleoli. (B) CD20 Immunostaining (Magnification: 100x) showing abnormally large B cells. (C.) CD10 Immunostaining (Magnification: 100x) showing large lymphoma cells are B cells (CD20+), which express CD10 (a germinal center marker), making this a germinal center B-cell lymphoma (Hand classification, Diffuse large B cell lymphoma). (D) The large B cells are weakly positive for BCL2 staining. (E.) B cells are mostly negative for MUM1 staining. (F) Ki67 staining (Magnification 10x) shows high Ki67 proliferative index in the lymphoid cells (low in background liver).
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The following day, the liver biopsy report showed B cell lymphoma (Fig. 2), which was thought to be the trigger for HLH.