PMC8677941_01
Enhancement of nasopharyngeal MRI scanning at different stages of treatment. (A) Initial enhancement MRI scanning revealed heterogeneous enhancement shadow filling in the left maxillary sinus at diagnosis. (B) After two cycles of V-CDOP chemotherapy, enhanced MRI scanning showed an excellent initial response with a substantial decrease in the size and intensity of nasopharyngeal lesions. (C) After four cycles of V-CDOP, MRI scanning revealed no significant change. (D) After radiotherapy and two cycles of RV-CDOP, subsequent enhancement MRI scanning revealed a reduction in the size of nasopharyngeal lesion. (E) Repeated enhancement MRI scanning after autologous hematopoietic stem cell transplantation (ASCT) showed increased abnormal signal shadows in the maxillary sinus, which was considered an inflammatory reaction. The nasopharyngeal lesions were indicated by yellow arrows.
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Initial enhancement MRI scanning on November 27, 2018, revealed heterogeneous enhancement shadow filling in the left maxillary sinus along with adjacent bone absorption (Figure 1A). After two cycles of V-CDOP, enhanced MRI scanning on February 11, 2019, revealed an excellent initial response, with a substantial decrease in the size and intensity of nasopharyngeal lesions (Figure 1B). After one cycle of V-CDOP, enhanced MRI scanning revealed no significant change on June 27, 2019 (Figure 1C). Subsequent enhancement MRI scanning revealed a reduction in the size of nasopharyngeal lesions on September 14, 2019 (Figure 1D). A repeated enhancement MRI scanning showed increased abnormal signal shadows in the maxillary sinus, which was considered as an inflammatory reaction on May 6, 2020 (Figure 1E).
Histopathological features of the plasmablastic lymphoma (PBL) patient. (A) PBL consists of large atypical cells, which cause destroyed architecture (H&E; scale bar, 500 mum). (B) The higher power view shows large-sized atypical cells with lymphocytic or plasmacytoid morphology, accompanied by obvious nucleoli and pathological mitotic features (H&E; scale bar, 100 mum). (C) The proliferation index was high with a Ki-67 expression of almost 95% (scale bar, 200 mum). (D) The immunohistochemical profile showed the neoplastic cells were strongly positive for the plasma cells markers CD38 (scale bar, 100 mum) and (E) MUM-1 (scale bar, 200 mum), positive for CD138 (scale bar, 100 mum) (F). (G) EBER in situ hybridization showed positive staining of plasmablasts (scale bar, 100 mum). The malignant cells did not express CD20 (scale bar, 100 mum) (H) and PAX-5 (scale bar, 100 mum) (I).
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Histology highlighted a diffuse infiltrate of large atypical cells with lymphocytic or plasmacytoid morphology (Figures 2A,B). Neoplastic cells expressed a high proliferative index (Ki-67, 95%) (Figure 2C). Immunohistochemical profiling showed positive results in neoplastic cells for MUM1, CD38, CD138, c-myc, and EBV-EBER, the ratio of kappa chain (+) neoplastic cells to lambda chain (+) neoplastic cells is greater than 64:1 (Figures 2D-F), and they were negative for CD30, CD19, CD79a, PAX-5, CD20, CD21, bcl-6, CD10, bcl-2, CD15, HMB45, S-100, MelanA, CK, and EMA (Figures 2G-I).18F-FDG PET/CT was performed for further assessment of the mass lesion metabolic activity and the general conditions at diagnosis on December 6, 2018.
18F-FDG PET/CT images of the PBL patient at various stages of treatment. (A) Transverse PET/CT scan showed a markedly FDG-avid mass at the left maxillary sinus that invaded the left nasal cavity, left orbital apex, and left alar mandibular space at diagnosis (SUVmax, 7.8; SUVmean, 6.3). (B) After five cycles of V-CHOP, re-evaluating PET/CT showed diminished range of lesions to 3.8 cm x 2.9 cm x 3.8 cm and reduced 18F-FDG uptake in the left maxillary sinus (SUVmax, 7.0; SUVmean, 4.5) and other locations (SUVmax, 4.0; SUVmean, 3.6). (C) After local radiotherapy and two cycles of RV-CDOP, PET/CT showed a complete metabolic response (cMR) with a diminished range of lesions to 1.0 cm x 1.3 cm and significantly reduced 18F-FDG uptake in the left maxillary sinus (SUVmax, 3.5; SUVmean, 2.5) and a lack of metabolic activity in other regions. (D) Follow-up PET-CT 16 months post ASCT showed continued cMR.
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A markedly FDG-avid space-occupying lesion was observed at the left maxillary sinus, and it invaded the left nasal cavity, left orbital apex, and left alar mandibular space (SUVmax, 7.8; SUVmean, 6.3) (Figure 3A). After three cycles of the V-CDOP regimen, re-evaluation of the 18F-FDG PET/CT in the transverse dimension on May 21, 2019, showed a diminished range of lesions to 3.8 cm x 2.9 cm x 3.8 cm and reduced 18F-FDG uptake in the left maxillary sinus (SUVmax, 7.0; SUVmean, 4.5) and other regions (SUVmax, 4.0; SUVmean, 3.6) (Figure 3B). The therapeutic assessment by FDG PET/CT on September 29, 2019, showed a complete metabolic response (cMR), a diminished range of lesions to 1.0 cm x 1.3 cm, significantly reduced 18F-FDG uptake in the left maxillary sinus (SUVmax, 3.5; SUVmean, 2.5), and a lack of metabolic activity in other regions (Figure 3C). Follow-up PET-CT on March 10, 2021 showed continued cMR 16 months after ASCT (Figure 3D).