case_images: PMC11079988_01
case_images: Histological findings of the mediastinal lymph node biopsy. A: Hematoxylin and eosin staining of the mediastinal lymph node shows clusters of plasma cells with eccentric nuclei (magnification x400). B-E: Immunohistochemically, the plasma cells are positive for CD138 (B), CD56 (C), and kappa (D), and negative for lambda (E).
case_images: jslrt-64-65-g001.jpg
case_images: PMC11079988_01_jslrt-64-65-g001.jpg
case_images: f1
case_images: A mediastinal lymph node biopsy was performed, and histopathology revealed clusters of plasma cells with eccentric nuclei (Fig. 1A). Immunostaining showed that these cells were positive for CD138, CD56, and kappa-chain (Fig. 1B-D) and negative for CD20 and lambda-chain (Fig. 1E).
case_images: Multiple liver tumors on CT. Plain CT shows three low-density areas in the S8 lesion (A, B). Contrast-enhanced CT shows ring enhancement of these tumors in the arterial phase and internal enhancement in two of the three tumors (C, D) that were washed out in the late phase (E, F).
case_images: jslrt-64-65-g002.jpg
case_images: PMC11079988_01_jslrt-64-65-g002.jpg
case_images: f2
case_images: CT scan revealed no new bone lesions, but multiple liver tumors (Fig. 2A, B). Contrast-enhanced CT revealed three ring-shaped contrast-enhancing masses in the S8 segment of the liver in the early phase (Fig. 2C, D). Of these, two masses were enhanced in the early phase and washed out in the late phase, whereas one mass showed a low-density area with unclear margins (Fig. 2E, F).
case_images: Gd-EOB-DTPA contrast-enhanced MRI shows multiple tumors with ring-shaped enhancement, with two small lesions in the left lobe, one small lesion in S5/6 in the arterial-dominant phase (A), and a high signal intensity on diffusion-weighted imaging (B). FDG-PET/CT showed minimal FDG uptake into the liver mass, with a maximum standardized uptake value of 3.33 for the S8 lesion (C) and no other extramedullary masses or bone lesions (D).
case_images: jslrt-64-65-g003.jpg
case_images: PMC11079988_01_jslrt-64-65-g003.jpg
case_images: f3
case_images: EOB-Primovist contrast-enhanced MRI showed that all three lesions of the S8 liver segment had a ring-shaped enhancement in the arterial-dominant phase (Fig. 3A), with reduced uptake in the hepatocellular phase, inside the lesions, and high signal intensity on diffusion-weighted imaging (Fig. 3B). In addition, two small lesions were found in the left lobe and one in the S5/6 segment (Fig. 3A, B). 18F-fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) showed minimal FDG uptake in the liver mass, with a maximum standardized uptake value of 3.33 for the S8 lesion (Fig. 3C), without other extramedullary masses or bone lesions (Fig. 3D).
case_images: Histological findings of the liver needle-biopsy specimen. A: Hematoxylin and eosin staining of the liver biopsy specimen shows monotonous infiltration of plasma cells (magnification x100). B-D: Immunohistochemically, the plasma cells are positive for CD138 (B) and kappa (C) and negative for lambda (D). Flow cytometry showed plasma cells were CD38-negative.
case_images: jslrt-64-65-g004.jpg
case_images: PMC11079988_01_jslrt-64-65-g004.jpg
case_images: f4
case_images: A liver biopsy was performed to confirm the diagnosis and revealed a monotonous infiltrate of CD138-positive, kappa-positive, and lambda-negative plasma cells with the same phenotype as that at the initial diagnosis (Fig. 4).