PMC5832667_01
Abdominal computed tomography (CT) findings. (a) before rectal surgery (b) after chemotherapy.. An abdominal CT scan performed after chemotherapy demonstrated significant reduction in the hepatic and splenic tumors.
gr1.jpg
PMC5832667_01_gr1.jpg
fig0005
Computed tomography (CT) scan showed rectosigmoidal wall thickening in the pelvis, a liver tumor in segment 5/6, splenic tumors (Fig. 1a), and a left lung tumor. CT scan performed after chemotherapy demonstrated significant reduction in size of the hepatic and splenic tumors (Fig. 1b), although the tumor in segment 10 of the left lung had enlarged.
Magnetic resonance imaging (MRI) findings.. Contrast-enhanced magnetic resonance imaging showed a signal-hypointense mass in segment 5/6 of the liver. A similar small nodule (arrowhead) was apparent in segment 3.
gr2.jpg
PMC5832667_01_gr2.jpg
fig0010
T1-weighted imaging showed a signal-hypointense mass in segment 3 of the liver, in addition to the already-known tumor in segment 5/6 (Fig. 2). The serum levels of CEA and CA19-9 decreased to 8.3 ng/mL and 7.7 U/mL, respectively.
Intraoperative findings.. The spleen was mobilized from the retroperitoneum laparoscopically.
gr3.jpg
PMC5832667_01_gr3.jpg
fig0015
First, the spleen was mobilized from the retroperitoneum using the three-port laparoscopic technique (Fig. 3).
Resected specimens of the splenic tumors.. Irregularly lobulated whitish masses were observed on the cut surface of the spleen.
gr4.jpg
PMC5832667_01_gr4.jpg
fig0020
Macroscopically, the splenic tumors were whiter and firmer than liver tumors (Fig. 4).
Pathological examination of the splenic tumor (H&E stain).. The tumor was composed of diffusely proliferating atypical cells with irregular medium to large, round or oval nuclei and a high nucleus/cytoplasm (N/C) ratio.
gr5.jpg
PMC5832667_01_gr5.jpg
fig0025
Microscopically, the splenic tumors demonstrated a diffuse proliferation of large lymphoid cells that were composed of diffusely proliferating atypical cells with irregular medium, to large round or oval nuclei and a high nucleus/cytoplasm (N/C) ratio (Fig. 5).
Immunohistochemistry.. The tumor cells were positive for the B-cell marker CD20, but not for CD3, CD5, and CD10. The Ki-67 index was 80-90%.
gr6.jpg
PMC5832667_01_gr6.jpg
fig0030
The Ki-67 index was 80-90% (Fig. 6).