PMC5903319_01
(a) Liver biopsy showing mild steatosis and dilated sinusoids, H&E stain, 4x magnification. (b) Extensive intravascular involvement of the liver by small atypical cells, H&E stain, 40x magnification. (c) Small intrasinusoidal lymphocytes highlighted by CD20, immunohistochemistry stain, 20x magnification. (d) The marrow showed involvement by atypical cells mostly of small size lymphocytes with an intrasinusoidal pattern, H&E stain, 40x magnification. (e) Small intrasinusoidal lymphocytes highlighted by CD20, immunohistochemistry stain, 20x magnification. (f, g) Subcutaneous vessel showing intravascular large atypical cells highlighted by CD20 confirming the diagnosis of IVLBCL, H&E, and immunohistochemistry stains, 40x magnification. (h, i) Small intrasinusoidal lymphocytes in the marrow in comparison with intravascular large atypical cells in the skin, H&E stains, 60x magnification.
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fig1
Consequently, a liver biopsy was performed, which was consistent with mild steatosis and dilated sinusoids (Figure 1(a)). After consulting with oncologists as well as the primary medicine team, random skin biopsies were performed, which showed morphologically classic IVLBL (Figures 1(d)-1(i)). On retrospect, review of the liver biopsy showed extensive intravascular involvement of the liver by small atypical cells highlighted by CD20 (Figures 1(b) and 1(c)).
PMC5903319_02
(a) Histopathologic exam of the small bowel revealed the diagnosis of IVLBCL with intravascular large atypical cells, H&E stain, 20x magnification. (b) Placenta also showed involvement of the disc (maternal blood) by IVLBCL including large atypical cells, H&E stain, 20x magnification. (c, d). Small atypical cells were seen in the small blood vessels of the breast, highlighted by CD20, H&E, and immunohistochemistry stains, 40x magnification. (e, f) Small lymphoma cells involving breast in comparison with large cells involving placenta, H&E stains, 60x magnification.
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fig2
Histopathologic exam of the small bowel revealed the diagnosis of IVLBCL (Figure 2(a)). Retrospective review of the placenta taken after the spontaneous abortion showed involvement of the disc (maternal blood) by IVLBCL including large atypical cells (Figure 2(b)). As it is shown in Figure 2(c), small atypical cells are present in the small blood vessels of the breast, highlighted by CD20 (Figure 2(d)).