PMC8732773_01
(A) PET scan showing an area with glucose uptake in the facial region. (B) PET/CT scan revealing the uptake area located in the left mandible.
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F1
Prior to hospitalization, the patient had a full-body positron emission tomography (PET) scan performed, which revealed an elevated glucose metabolism in the left alveolar branch of the mandible (standardized uptake value (SUV) max = 5.87) (Figure 1). Five cycles of R-CHOP were administered and another full-body PET-CT was performed, which showed a decline of glucose metabolism in the left mandible region (Supplementary Figure 1).
CNV analysis of the patient's autosomes and sex chromosomes. Both plasma and mandibular biopsy samples showed large CNVs on chromosomes 1, 5, 6, 11, and 14. The same analysis using buccal swab showed normal copy numbers.
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F2
Meanwhile, the chromosomal copy number analysis showed significant alterations (both duplications and deletions) in chromosomes 1, 5, 6, 11, and 14, which indicated the presence of malignant tumor DNA (Figure 2).
Left mandible biopsy and immunohistochemistry. (A) Multiple fragments of a squamous mucosa and soft tissue with a dense lymphoid infiltrate (x100 magnification). (B) Aggregate of atypical lymphoid cells (H&E staining; x200 magnification). (C) Immunohistochemical staining showing sheets of large mononuclear lymphoid cells positive for CD20 (x100 magnification). (D) Sheets of large mononuclear lymphoid cells positive for CD79a (x100 magnification). (E) Cells positive for Bcl-2 staining (x100 magnification). (F) Cells positive for Ki67 staining (x100 magnification).
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F3
A biopsy of the left mandible was taken, and the immunohistochemical results showed cells positive for CD20, CD79a, Bcl-2, CD5 and c-myc, and Ki-67 value-added index was 90% (Figure 3).