PMC8443791_01
CT examination before-treatment. Axial (A), Axial (B), and coronal (C) enhanced CT images of the abdomen and pelvis in the portal phase. Extensive ascites (stars), thickening of the peritoneum (red arrow), and marked thickening of the omentum (white arrows) noted. No enlarged lymph nodes were noted.
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Cervicothoracic and whole abdominal computed tomography (CT) scan without any intestinal involvement, tumor formation, or enlarged lymph nodes revealed diffuse thickening of peritoneum and omentum, thoracic, abdominal, and pelvic effusion (Figure 1), inflammation in the inferior lobe of the right lung, strip shadow of hepatic hilum and hepatogastric space, dilatation of intrahepatic bile duct, as well as edema and thickening of gallbladder wall.
Histopathology from the omental thickening biopsy. (A) Hematoxylin-eosin staining showed diffuse infiltration of neoplastic lymphoid cells (400x). Tumor cells were immunoreactive for (B) CD20, (C) CD10, (D) and expressed high Ki-67 index (nearly 90%) (400x).
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Immunohistochemical stain subsequently showed positivity for CD10, CD20, PAX-5, and c-myc with proliferative fraction of 90% (Figure 2), negativity for CD3, CD56, CD138, and Mum-1, which was in favor of the diagnosis of diffuse large B-cell lymphoma, germinal center B-cell type, stage IV.
CT examination post-treatment. Axial (A), Axial (B), and coronal (C) enhanced CT images of the abdomen and pelvis in the portal phase post-treatment demonstrated resolution of ascites, thickening of peritoneum and omentum disappeared and turned to the normal shape.
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Follow-up CT reexamination demonstrated remission of his condition (Figure 3).