PMC10102472_01
Contrast-enhanced abdominal CT (A-C) scan showed volumetric disproportion of lobar and segmental of the slightly enlarged liver with massive abdominal-pelvic fluid accumulation. Full-body PET-CT scan (D-F) showed no significant hypermetabolism but a slightly low signal from the subcapsular area in the right hepatic lobe with ascites and splenomegaly. Red arrows point to the subcapsular area in the right hepatic lobe with ascites.
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Figure 1 ). Further full-body PET-CT images correspond to contrast-enhanced abdominal CT and disclosed no significant hypermetabolism (shown in  Figure 1 ).
Cells from ascites were centrifuged and then stained. (A, B) Heterogeneous lymphoid-like cells were distributed in a scattered pattern, hematoxylin-eosin staining in A, papanicolaou staining in B, magnification x100. (C-E) Ascites cells were positive for CD20, CD79alpha, LCA, magnification x100. (F) FISH analysis revealed that 20%-30% of the ascites cells exhibited c-MYC amplification, magnification x100.
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Histology suggested that the ascites puncture cytology contained aggressive of large-sized B lymphocytes positive for CD20, CD79alpha, LCA, c-MYC (shown in  Figure 2 ), and other biomarkers, such as PAX5(+), CD3(+), CD19(+), CD34(-), HHV8(-), Ki-67(+, 60%), BCL-6(+), MUM1(-), sox11(-), EMA(-), and MPO(+) consistent with the result of the immunohistochemical staining of bone marrow biopsy, which presented CD20(+), CD79alpha(+), CD3(+), BCL-6(-), MPO(+) (shown in  Figure 3 ), CD10(-), Ki-67(+, 1%<), and MUM(-).