PMC6037664_01
Radiological findings of CT. (A) CT scan on admission, demonstrating marked circumferential left pleural thickening, and pleural effusion in the left chest. (B) FDG-PET demonstrating intense FDG uptake by the left pleura. (C) CT scan after the chemotherapy, demonstrating disappearance of the tumor.
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Whole body computed tomography (CT) showed the marked circumferential left pleural thickening, and pleural effusion in the left chest (Fig. 1(A)). Fluorodeoxyglucose positron emission tomography (FDG-PET)/CT, performed after 10 days, revealed the progressively increased pleural thickening with an intense FDG uptake (Fig. 1(B)). Following salvage chemotherapy with 3 courses of R-Hyper CVAD/MA therapy (a regimen of rituximab, hyper-fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with rituximab, methotrexate and cytarabine), the tumor disappeared (Fig. 1(C)).
Histological findings of the pleural biopsy. (A) The proliferative lymphoid cells were medium- to large-sized with conspicuous nucleoli. Macrophages were scattered among the lymphoid cells, representing a "starry sky" appearance. (hematoxylin-eosin staining; objective magnification, 40x). (B) The lymphoid cells were positive for TNF. (objective magnification, 40x). (C) The lymphoid cells were positive for IL-6. (objective magnification, 40x). (D) Approximately 90% of the lymphoid cells were positive for Ki67. (objective magnification, 40x).
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Tingible body macrophages were scattered among them, representing a "starry sky" appearance (Fig. 2(A)). TdT. The lymphoblastoid cells were also positive for tumor necrosis factor (TNF) (52B83; Santa Cruz Biotechnology, Santa Cruz, CA) (Fig. 2(B)) and interleukin-6 (IL-6) (10C12; Novocastra, Newcastle Upon Tyne, UK) (Fig. 2(C)). The proliferation index, as assessed by Ki67 (30-9; Ventana Medical Systems, Tucson, AZ) (Fig. 2(D)), was approximately 90%.
Southern blot analysis of the immunoglobulin heavy chain gene. Lane 1: EcoR I digestion. Lane 2: BamH I and Hind III digestion. Lane 3: Hind III digestion. The red arrows indicate clonal rearranged bands. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
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Southern blotting revealed clonal rearrangement of the immunoglobulin heavy chain gene (Fig. 3).