PMC5448865_01
Bone marrow aspirate showing abnormal histiocytes and prominent phagocytosis of red cells, neutrophils, and platelets, compatible with hemophagocytosis under Liu's stain with 100x power field.
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Bone marrow smear showed severe hemophagocytosis (Figure 1) and no abnormal population or light chain restriction indicated by flow cytometry.
(a) Abdominal ultrasonography showing multiple hypoechoic lesions up to 2.07 cm on both lobes, (b) abdominal computed tomography showing ill-defined poor enhancing nodular lesions (yellow arrow) on both hepatic lobes, (c) the pathology of liver tumor specimen under H&E stain with 200x power field, and (d) these atypical cells were positive for CD20.
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Moreover, abdominal ultrasonography disclosed multiple hypoechoic lesions up to 2 cm on both lobes (Figure 2(a)). Abdominal computed tomography (CT) showed multiple ill-defined poor enhancing nodular lesions on both hepatic lobes (Figure 2(b)). B cell lymphoma (Figure 2(c)), identifying lymphoma cells CD20+/CD10-/BCL-6+/BCL-2+/cyclin D1-/EBER- (Figure 2(d)). Because of old age, multiple comorbidities, and the fragile clinical status of the present case, we initiated chemotherapy with rituximab and bendamustine (rituximab 375 mg/m2 for 1 day; bendamustine 90 mg/m2 for 2 days).
Small hypovascular hepatic lesions (yellow arrow) decreased in size compared with a prior study (Figure 2(b)) after the second cycle of chemotherapy.
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After the second cycle of chemotherapy, abdominal CT revealed excellent treatment response with much smaller hypovascular lesions at both hepatic lobes compared with the prior study (Figure 3).