PMC9106524_01
(a) Wright-Giemsa stain of peripheral blood smear shows circulating large atypical lymphoid cells, highlighted with arrows (1000x). (b) The hematoxylin and eosin section shows diffuse proliferation of large pleomorphic lymphoid cells in the cervical lymph node (600x). (c-f) Immunohistochemical stains (all 600x) demonstrate that the cervical lymph node neoplastic cells are positive for CD20 and SOX-11, while negative for cyclin-D1. Ki-67 highlights a very high proliferative index of ~90%.
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fig1
Laboratory evaluation was significant for leukocytosis of 59.3 (cells/L) with a differential of largely atypical lymphocytes (Figure 1(a)) and LDH elevated to 1246 (IU/L). A right cervical lymph node biopsy revealed a diagnosis of blastoid variant MCL, further characterized as cyclin-D1 negative, SOX-11 positive, and p53 negative with a Ki-67 index of approximately 90% (Figure 1(b)-1(f)).
(a) Pretreatment axial and sagittal T1 weighted fat saturated postcontrast images show abnormal enhancement along the dorsal aspect of the spinal cord at the level of L1 and L2, with abnormal enhancement along the cauda equina nerve roots. Findings are highly suspicious for leptomeningeal disease with a differential of infectious and inflammatory etiologies. (b). Post-treatment axial and sagittal T1 weighted fat saturated postcontrast images show markedly improved enhancement at the level of L1 and L2 and of the conus medullaris and cauda equina nerve roots, with very subtle minimal enhancement.
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An MRI brain/orbits did not demonstrate signs of leptomeningeal disease or obvious abnormality to explain symptoms, but an MRI of the spine showed lumbar enhancement concerning disease involvement (Figure 2(a)). Repeat MRI spine after completion of therapy demonstrated CR (Figure 2(b)) with the resolution of symptoms and repeat PET/CT imaging showed CR2.