PMC4702294_01
Diffuse large B-cell lymphoma (DLBCL) in lymph node biopsy. Immunohistochemistry revealed IgG staining in the cytoplasm of some neoplastic cells (IgG stain; original magnification, x200). Absence of CD38 expression in neoplastic cells and a positive staining in intermingled plasma cells (original magnification, x400). Absence of CD138 stain in neoplastic cells (original magnification, x400)
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Fig1
BCL2-, BCL6+, MUM1+, suggesting a non-GCB origin, and suggestive for IgG expression (Fig. 1). Bone marrow trephine biopsy proved the presence of concordant DLBCL involvement.
Trend of gamma-globulin dosage during the disease course
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Fig2
At this time the MG remained stable (Fig. 2). For the first time paraprotein was no longer detectable and immunofixation (IF) was negative as well (Fig. 2). Interestingly, the reappearance of a monoclonal IgG and of FLC k/l abnormal ratio preceded relapse (Fig. 2).
Computed tomography (CT) of the torax. a Pathological tissue with elongated morphology of maximum diameter of 6 cm. b Almost complete disappearance of the pathological mass previously observed
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Fig3
Disease restaging after treatment completion revealed progressive disease (PD) (Fig. 3) as well as an increase of the MG (Fig. 2). Two months after treatment start, the patient's general conditions improved and after 5 months he achieved a complete remission (CR) (Fig. 3).