PMC5266403_01
Pleural effusion showing large and pleomorphic cells with immunoblastic or anaplastic features in cytospin or cell block preparation, which were positive for CD20 and MUM-1 with weak-to-moderate intensity, but negative for CD138, human herpesvirus 8 (HHV8), and Epstein-Barr virus-encoded small RNA, showing a high Ki-67 proliferating index: Papanicolaou (PAP) (x100) (A), PAP (x400) (B), H&E (x400) (C), CD20 (D), MUM-1 (E), CD138 (F), HHV8 (G), Epstein-Barr virus (H), and Ki-67 (I).
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The cytological evaluation of both the pleural effusion and ascites demonstrated numerous large and pleomorphic cells with eosinophilic macronucleoli and abundant cytoplasm, with an immunoblastic or anaplastic appearance (Fig. 1A-C). Epstein-Barr virus (EBV)-encoded small RNAs in situ hybridization showed no EBV-infected cells (Fig. 1D-I).
Imaging study at the time of diagnosis and after completion of chemotherapy: computed tomography (CT) at diagnosis (A), positron emission tomography-computed tomography (PET-CT) at diagnosis (B), CT after six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) (C), and PET-CT after six cycles of R-CHOP (D).
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CS detected some tubular adenomatous polyps, which were confirmed as benign. CT scans showed a large pleural effusion, contrast enhancement of the peritoneum, and prostatic enlargement (Fig. 2A). Diffuse hypermetabolism along the omental and peritoneal infiltration was detected on the PET-CT scan (Fig. 2B), and no significant abnormal uptake was detected on the bone scan. The CT scan showed almost complete resolution of the pleural effusion and ascites with a decrease in the omental infiltration and peritoneal thickening with no metabolic activity on the PET-CT (Fig. 2C and D).