PMC5088550_01
CT images on admission and 10 months after the disease onset. (A-D) Images on admission showed mediastinal and para-aortic lymphadenopathy (<1.5 cm in diameter), bilateral pleural effusions, ascites and mild splenomegaly. (E-H) Ten months after the disease onset, abdominal and pelvic lymphadenopathy and a left adrenal mass were observed. There was no change in the size of the mediastinal lymph nodes. pleural effusion and ascites were not observed.
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Computed tomography (CT) revealed mediastinal and para-aortic lymphadenopathy (<1.5 cm in diameter), bilateral pleural effusions, ascites and splenomegaly (Fig. 1A-D). A CT scan demonstrated abdominal and pelvic lymphadenopathy and a left adrenal mass (Fig. 1E-H).
Histological findings of the bone marrow. (A) The mixture of hypocellular and hypercellular marrow with increased megakaryocytes was observed without pathologic cells, dysplastic changes or hemophagocytosis. Hematoxylin and Eosin staining, 100x. (B) Mild hyperplasia of reticulin fibrosis was observed. Silver stain, 100x.
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A bone marrow biopsy exhibited a mixture of hypocellular and hypercellular marrow with increased megakaryocytes and mild fibrosis without pathologic cells, dysplastic changes or hemophagocytosis (Fig. 2).
Positron emission tomography (PET) -CT imaging 10 months after the disease onset. 18F-fluorodeoxyglucose uptake were observed in the right cervical, mediastinal, abdominal para-aortic, iliac lymph nodes, left shoulder [maximum standardized uptake value (SUVmax) 39.2], left adrenal mass (SUVmax 33.0) and liver (SUVmax 9.3).
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Increased FDG uptakes in the right cervical, mediastinal, abdominal para-aortic, iliac lymph nodes, left shoulder [maximum standardized uptake value (SUVmax) 39.2], left adrenal mass (SUVmax 33.0) and liver (SUVmax 9.3) were observed by PET-CT (Fig. 3).
Histological findings of the right cervical lymph node. (A) Hematoxylin and Eosin (H&E) staining, 40x. (B) H&E staining, 200x. The lymph node showed hyperplasia of lymphoid follicles and non-atrophic germinal centers. Infiltration of plasma cells in the interfollicular area and proliferation of endothelial cells were unremarkable. Neoplastic features were not detected.
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A biopsy of the right cervical lymph node showed follicular hyperplasia without neoplastic features (Fig. 4).
Histological and immunohistochemical findings of the abdominal lymph node. (A) Hematoxylin and Eosin staining, 200x. (B) CD20 immunostaining, 200x. (C) Ki-67 immunostaining, 200x. The basic structure of the lymph node had disappeared and diffuse proliferation of large atypical lymphoid cells with prominent nucleoli and frequent mitotic figures was demonstrated. These cells were positive for CD20, CD79a, B-cell lymphoma (BCL) -2, BCL-6, and multiple myeloma oncogene-1 and negative for CD3, CD5, CD10 and Epstein-Barr virus-encoded RNAs. The Ki-67 labeling index was elevated. These findings were consistent with DLBCL.
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A surgical biopsy of the abdominal para-aortic lymph node and a core needle biopsy of the left shoulder mass were performed, and the histopathologic findings of both were consistent with non-Hodgkin's lymphoma of diffuse large B-cell type (Fig. 5).