PMC4324466_01
(A) Homogenous enhancing mass in the lesser omentum located in front of the pancreas. (B) Heterogeneous enhancing mass located below the liver.
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Another subhepatic heterogeneous enhancing mass of 5.9 x 8.6 x 7 cm was also detected and a retroperitoneal lymph node without involvement of adjacent structures, suggestive of lymphoma (Fig. 1A and B).
Pre-chemotherapy 18-FDGPET/CT showing multiple retroperitoneal and intra-abdominal infiltrations.
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The 18-FDGPET/CT showed two hypermetabolic masses, corresponding to those described on CT, with multiple retroperitoneal and right iliac hypermetabolic lymph nodes (Fig. 2).
(A) Clusters of small lymphocytes and epithelioid cells with eosinophilic cytoplasm and indistinct borders. (B) Sheets of ovoid cells with vesicular nuclei and pale eosinophilic cytoplasm. Note the mitotic activity, syncitial appearance, and the presence of interspersed lymphocytes. (C) CD23 immunostaining, x 40.
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Histopathologic assessment of the resected specimen showed clusters of small lymphocytes and epithelioid cells with eosinophilic cytoplasm and indistinct borders (Fig. 3A). We note also mitotic activity, syncitial appearance, and the presence of interspersed lymphocytes (Fig. 3B). Immunohistochemical staining showed cells that were strongly positive for the FDCS marker CD23 (Fig. 3C) and negative for CD20, S-100-protein, and CD1a.
(A) Residual mass after the first four cycles. (B) Post-chemotherapy (first line) 18-FDGPET/CT showing complete metabolic response. (C) Complete radiologic response at the end of the first line of chemotherapy.
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A post-chemotherapeutic 18-FDGPET/CT performed six months after diagnosis showed a partial metabolic response and a macroscopic mass was still visible on CT after the first four cycles (Fig. 4A), and a complete metabolic and radiologic response at the end of the first line (Fig. 4B and C).