PMC8188037_01
Bone marrow biopsy specimens. A: Wright-Giemsa stain; magnification, x40. B: Immunostaining for CD20; magnification, x40. C: Immunostaining for cyclin D1; magnification, x40. Sporadic cyclin D1-positive cells were observed. D: Fluorescence in situ hybridization with a bone marrow analysis for BCL1/IgH fusion signals.
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Immunohistochemistry of the pathological bone marrow tissue revealed cyclin D1 and CD20-positive lymphocytes infiltrating a small amount of bone marrow (Fig. 1A-C). Fluorescence in situ hybridization with a bone marrow analysis for BCL1/IgH fusion signals showed signals in only 3.5% of normal nuclei (Fig. 1D).
A: Positron emission tomography-computed tomography image acquired prior to treatment. The spleen showed an abnormal uptake. B and C: Positron emission tomography-computed tomography image acquired prior to treatment. Although the pelvis and vertebral bodies showed a weakly abnormal uptake, maximum standardized uptake values could not be determined; we were thus unable to confirm the presence of malignant lymphoma cells in these regions. D: Contrast-enhanced computed tomography revealed infarction of a portion of the spleen (indicated by white arrow). E: Positron emission tomography-computed tomography image acquired after treatment. An abnormal uptake was absent. F: Positron emission tomography-computed tomography image acquired during recurrence of severe thrombocytopenia. The spleen showed an abnormal uptake and regrowth.
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Furthermore, no lymphadenopathy or abnormal uptake was observed, except in the spleen (Fig. 2A-C). During third-line treatment, the patient reported abdominal pain; therefore, we performed contrast-enhanced computed tomography, which revealed splenic infarction (Fig. 2D). The patient exhibited complete remission of his MCL (Fig. 2E) after four courses of VR-CAP, and his platelet count remained normal. Positron emission tomography-computed tomography again revealed splenomegaly, with a maximum standardized uptake value of 6 (Fig. 2F).
Clinical course. IVIG: intravenous immunoglobulin, PSL: prednisone, R: rituximab, VR-CAP: bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisolone, R-B: rituximab and bendamustine, PC: platelet concentrate
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The patient's clinical course is shown in Fig. 3.