PMC6305443_01
Cervical lymph node pathology. (A) Effacement of lymph node architecture, with vague nodular growth pattern. (B) Increased CD20 tissue staining in the lymph node tissue. (C) Increased CD20 tissue staining in the lymph node tissue (40x magnification). (D) EBV in situ hybridization:positive staining for EBV in a small amount of scattered lymphoid cells.
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F1
An excisional biopsy of a left cervical lymph node revealed initial findings concerning for malignancy due to lymph node architecture effacement Figure 1A and increased CD20 staining Figures 1B,C as well as B cell clonality on flow cytometry (31-33% of the B cell population was aberrant exhibiting CD45+, CD19+, CD20+, CD5-, CD10-, CD23dim+, CD22+, FMC7 bright+, sIg Kappa dim+). T cells, B cells, and blasts Figure 1D.
CT head and neck, chest, abdomen, and pelvis. (A) CT demonstrating left greater than right scattered cervical lymphadenopathy. (B) Bilateral parotid gland enlargement, left greater than right. (C) Mediastinal and hilar lymphadenopathy, multiple calcified and noncalcified lung nodules, lung cysts, and bronchiectasis. (D) Hepatosplenomegaly, abdominal and pelvic lymphadenopathy as well as marked thickening of the distal through terminal ileum wall and the wall of the cecum extending up to the hepatic flexure.
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F2
In addition to asymmetrical cervical lymphadenopathy and parotid gland enlargement Figures 2A,B, a CT neck/chest/abdomen and pelvis done at that time showed mediastinal, hilar, abdominal, and pelvic lymphadenopathy, impressive retroperitoneal lymphadenopathy, hepatosplenomegaly, and cecum and terminal ileum thickening Figures 2C,D.