PMC7288794_01
Multi-phase magnetic resonance imaging (MRI) at 1, 5, and 10 minutes (A, B,
and C, respectively) showing a multi-lobulated, non-vascular 3.5 x 4.9 cm
progressive heterogeneous enhancement in the spleen. (D) A section of the
resected spleen showing the primary splenic diffuse large B-cell lymphoma
lesion.
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A CT scan of the abdomen showed left-sided colitis, no pathologically enlarged lymph nodes, and an enlarging splenic lesion. An abdominal multi-phase magnetic resonance imaging (MRI) showed the splenic lesion to be 3.5 cm x 4.9 cm in size, multi-lobulated, non-vascular, and with progressive heterogeneous enhancement in the spleen (Figure 1A-C). Examination of the spleen revealed a nearly 5 cm mass (Figure 1D).
(A) Hematoxylin and eosin (H&E) staining of the solid splenic lesion
showing large highly atypical lymphoid cells, including a few very large
multi-nucleate and anaplastic cells. Immunohistochemical staining of the
sample was positive for CD20 and BCL6 (B and C, respectively). The Ki-67
stain (D) indicated a principally 100% proliferation index in B-cells.
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The Ki-67 proliferative index was expressed in nearly 100% of B-cell nuclei (Figure 2A to D).
PMC7288794_02
Peripheral blood smear showing lymphocytosis with (A) small mature
lymphocytes and (B) occasional lymphocytes with cytoplasmic projections
(arrow). (C) Whole body 18fluorodeoxyglucose positron emission
tomography/computerized tomography (18FDG-PET-CT) scout film
showing splenomegaly and diffuse increased uptake in the spleen. (D)
Follow-up 18FDG-PET-CT showing complete metabolic response.
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Peripheral blood showed atypical lymphocytes with occasional cytoplasmic projections (Figure 3A and B). A subsequent 18FDG-PET-CT showed diffusely increased metabolic activity within the spleen and para-aortic lymph nodes with a maximum standardized uptake value (SUV) of 3.4, hepatomegaly with no focal intensity, and mildly diffuse marrow activity suggestive of marrow expansion (Figure 3C). Follow-up 18FDG-PET-CT imaging 1 month after completion of treatment showed complete metabolic response and reduction in the spleen size to 14 cm (maximal dimension; Figure 3D).