PMC8457982_01
Abdominal ultrasound revealing dilated common bile duct measuring (a) 2.05 cm and gall bladder with (b) biliary sludge.
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Abdominal ultrasound showed a distended gallbladder with sludge and stones and a dilated common bile duct measuring 21 mm (Figure 1).
Lytic changes and destruction of sphenoid bone with adjacent right middle cranial fossa mass. (a) Head CT: bone window focusing on the destruction of the right sphenoid wing. (b) Head CT: brain window focusing on 3.0 x 4.4 x 2.4 cm peripherally enhancing mass in the right middle cranial fossa. (c, d) Brain MRI showing 2 x 2.9 x 5.2 cm right temporal region mass and irregularity under the right sphenoid wing and an adjacent 4.5 x 3.1 x 2.5 cm intracranial mass.
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Computerized tomography (CT) of the facial bones revealed an abnormal right sphenoid wing with lytic changes, destruction, and a medially adjacent 3.0 x 4.4 x 2.4 cm peripherally enhancing lesion in the right middle cranial fossa (Figures 2(a) and 2(b)). There was irregularity of the right sphenoid wing with an adjacent 4.5 x 3.1 x 2.5 cm intracranial mass (Figures 2(c) and 2(d)).
Right middle fossa biopsy showing (a) H&E stain, (b) CD20+ cells, and (c) CD10+ cells.
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CT-guided biopsy of the right middle fossa mass revealed a high-grade small blue cell tumor, suggestive of non-Hodgkin lymphoma (Figure 3).
CD20-positive cells detected from pancreatic and gastric biopsies. (a, b) fine needle aspiration (FNA) of the pancreas stained with hematoxylin and eosin (H&E) and CD20. (c, d) Gastric lesion biopsy stained with H&E stain and CD20.
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B-cell lymphoma (Figures 4(a) and 4(b)). Biliary sphincterotomy with metal stent placement at the stricture site was then performed via endoscopic retrograde cholangiopancreatography (ERCP), draining a large quantity of the biliary sludge. Multiple gastric lesions were identified during the procedure, with biopsies revealing diffuse infiltration of lamina propria by atypical CD20+ lymphoid cells with crypt involvement (Figures 4(c) and 4(d)).