PMC9925213_01
Abdominal ultrasonography. Multiple variable-sized hepatic complex cystic focal lesions
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Fig1
He sought medical advice, and his doctor asked for abdominal ultrasonography (Fig. 1).
Whole-body PET-CT. Variable-sized metabolically active bilobar focal hepatic lesions in addition to active marrow-based osseous lesions at L1 vertebral body and proximal RT femoral shaft
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Fig2
The suggested provisional diagnosis includes lymphomas vs metastatic multifocal primary hepatic malignancy (Fig. 2).
Abdominal MRI. Heterogeneous low T1 and higher T2 signal with some element of diffusion restriction along its periphery
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Fig3
He considered metastatic vs multifocal HCC (Fig. 3).
Histopathology and immunohistochemical staining. Diffuse sheets of large lymphoid cells with large irregular nuclei, focally showing prominent nucleoli and many nuclear debris (H&E x 400), diffusely positive for CD20 (inset, immunostain x 100)
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Fig4
The findings are consistent with large B-cell lymphoma and post germinal center origin (activated B-cell type) (Fig. 4).
Posttreatment whole-body PET-CT. Morphological regression of the metabolically inert multiple hepatic focal lesions with no newly developed metabolically active lesions
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Fig5
Three months after, the chemotherapy sessions were fulfilled; a follow-up PET-CT was done and showed further morphological regression of the metabolically inert multiple hepatic focal lesions with no newly developed metabolically active lesions all over the body, indicating sustained complete metabolic disease remission (Fig. 5).