A 68-year-old woman with no toxic habits or history of interest was admitted for a condition of continuous pain in the right hypochondrium, asthenia, anorexia and loss of five kilograms of weight since a month before.
In the previous weeks, no fever, flu, respiratory or digestive symptoms were observed.
1.
Physical
Affectation of the general state; eupneic; normal skin-mucosal coloration; Neither thyroid nor cervical, supraclavicular or axillary adenomegaly were observed.
TA: 130/70 mmHg; temperature 37.0 oC.
Cardiopulmonary arrest was normal.
Abdomen: palpable liver three centimeters of right costal margin and five centimeters of xiphoid, exceeding the midline, firm and painful; non-palpable spleen.
Extremities: no alterations.
1.
Establishment plan
Complete blood count: hemoglobin (Hb) 12 g/dl (normal 12-16); hematocrit 36% (48); MCV 860,000; leukocytes 7,800/mm3 (4.500-10,000); platelets 228.000/mm).
ceftaroline prothrombin 97% (70-120); cefalin time 27 seconds (25-34 s); fibrinogen 506 mg/dl (200-400).
103 mg/dl (70-105); creatinine 0.79 mg/dl (0.7-1,10); GOT 115 U/l
Tumour markers: CA 15.3 antigen: 12 IU/ml (normal < 30), CA 54.9: 3 IU/ml (< 12), CA 125: 5 IU/ml (< 35), CA 19.9: 8 U/ml
Hepatitis B and C and HIV serology were negative.
Electrocardiogram showed no abnormalities.
Chest X-ray showed no abnormalities.
Abdominal radiography: hepatomegaly.
Abdominal ultrasound: multiple solid liver lesions, one to three centimeters in diameter, suggestive of metastasis; no other findings.
Abdominal CT: multiple solid and hypodense lesions occupying almost the entire liver, with a diameter similar to that found on ultrasound; no axillary, retroperitoneal or mesenteric adenomegaly was found.
Colonoscopy showed no findings.
Needle aspiration biopsy (FNAB) of a CT-guided hepatic lesion: non-Hodgkin lymphoma.
Liver biopsy with CT control: diffuse large B-cell lymphoma.
Immunohistochemically, atypical cells negative for lymphoid phenotype B (CD20 and CD79α positive), positive for CD10 and bcl 6, and for markers T (CD3); CD 43, bcl 2 and AE1 keratins.
Mantoux: 9 mm. Bone marrow study: aspirated without pathological findings; blood clot and bone marrow biopsy with no signs of abnormality.
Molecular biology: CDR1 region of polyclonal IgH gene.
Cerebrospinal fluid examination showed no biochemical or cytological abnormalities.
Cranial CT was normal.
Gammagraphy with 67Galio: no pathological findings.
