PMC6663525_01
Imaging studies of the hepatobiliary system. (a) Ultrasonogram revealing an extremely thickened gallbladder wall and fluid collection (*) on admission. (b) The thickness of the gallbladder wall regressed 5 days after admission. (c) A computed tomography scan showing an extremely thickened gallbladder wall (arrowheads) and fluid collection (*) on admission. (d) A hypovascular area of the liver is shown (arrowheads) 9 days after admission.
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Abdominal ultrasonography (US) and computed tomography (CT) examinations revealed gallbladder wall thickening and fluid collection without gallstones (Fig. 1a and c). A US examination showed a regression of the gallbladder wall thickness within 5 days after admission (Fig. 1b). A CT examination 9 days after admission also showed a regression of gallbladder wall thickness; however, hypovascular areas in the liver newly appeared (Fig. 1d).
The patient's clinical course. BT: body temperature, CRP: C-reactive protein
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She died 21 days after admission (Fig. 2).
Pathological findings. (a-c) Microscopic findings of the gallbladder. (a) Thickened gallbladder wall and small vessels are filled with lymphoid cells. (b) Large lymphoid cells with atypical nuclei are observed. (c) Lymphoma cells are positive for CD20. (d-f) Pathological findings of the liver. (d) Macroscopic findings of the liver showing unclear segmental lesions (arrowheads). (e) Sinusoids in the segmental lesion are filled with lymphoma cells. (f) Lymphoma cells are positive for CD20.
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The small veins in the mucosa and submucosa were filled with large atypical lymphocytes (Fig. 3a and b). Liver masses were unclearly demarcated (Fig. 3d). Microscopically, sinusoids and hepatic veins in the liver mass were also invaded with atypical lymphocytes (Fig. 3e). Atypical lymphocytes were CD20(+) (Fig. 3c and f), CD79a(+), BCL6(+), MUN1(+), CD3(+), CD10(-), IMP3(-), EBV-LMP1(-), and CD56(-) according to the immunohistochemical examination.