case_images: PMC4137732_01
case_images: Computer tomography of the abdomen showing multiple intra-abdominal/pelvic masses and massive ascites.
case_images: CRIHEM2014-619760.001.jpg
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case_images: fig1
case_images: Bilateral pleural effusions were also seen (Figure 1).
case_images: (a) 100x H&E image shows a monomorphic infiltrate of small round blue cells with adjacent necrosis, (b) 400x H&E high power demonstrates medium sized cells with admixed apoptotic bodies and mitotic figures reminiscent of Burkitt or a Burkitt-like lymphoma, and (c) Ki-67: high proliferation rate over 90% supports the morphologic impression and is indicative of an aggressive lymphoma.
case_images: CRIHEM2014-619760.002.jpg
case_images: PMC4137732_01_CRIHEM2014-619760.002.jpg
case_images: fig2
case_images: The ki-67 proliferation rate was 95% (Figure 2), findings consistent with a high grade lymphoma such as Burkitt's or a B-cell lymphoma, unclassifiable with features intermediate between diffuse large diffuse B-cell lymphoma and Burkitt lymphoma.
case_images: (a) Flow cytometry of the ungated specimen of the abdominal mass showing a Cd45 bright population, compatible with a lymphoproliferative process (rather than a carcinoma, melanoma, etc.), (b) gating only the CD45 bright/low side scatter population shows a predominant CD20+/CD10+ population, consistent with a B-cell population of germinal center origin, and (c) light chain expression shows lambda light chain restriction, diagnostic of a B-cell lymphoma.
case_images: CRIHEM2014-619760.003.jpg
case_images: PMC4137732_01_CRIHEM2014-619760.003.jpg
case_images: fig3
case_images: Flow cytometry of the abdominal mass was also suggestive of an aggressive B-cell lymphoma (Figure 3).
case_images: FISH analysis using Abbott Tri-color Dual fusion Translocation Probe hybridized to a nucleus revealing, (a) an IgH/c-myc rearrangement by the juxtaposition of the red (c-myc) and green (IgH) yielding the yellow fusion. One native c-myc (red) and native IgH (green) are also present; (b) a BCL-2/IgH rearrangement by the juxtaposition of the red (BCL-2) and green (IgH) yielding the yellow fusion. One native BCL-2 (red) and native IgH (green) are also present.
case_images: CRIHEM2014-619760.004.jpg
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case_images: fig4
case_images: Subsequent FISH testing was positive for t(8;14), c-myc-IgH translocation, and a t(14;18) IgH-BCL2 translocation (Figure 4).
case_images: WHOLE BODY PET-CT showing multiple areas of hypermetabolic activity in the abdomen with hypermetabolic bony lesions suspicious of extensive metastatic disease.
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case_images: PMC4137732_01_CRIHEM2014-619760.005.jpg
case_images: fig5
case_images: Multiple foci of hypermetabolic activity throughout the bones, suspicious for osseous metastatic disease, were also noted (Figure 5).
case_images: (a) Flow cytometry of the ungated bone marrow aspirate shows 16% cellularity in the CD45 bright/low side scatter gate, (b) gating only the CD45 bright/low side scatter gate shows a population of CD10+/CD20+ lymphocytes representing 7% of overall cellularity, and (c) this population shows dim surface lambda light chain restriction, all findings consistent with a low grade lymphoma of germinal center origin.
case_images: CRIHEM2014-619760.006.jpg
case_images: PMC4137732_01_CRIHEM2014-619760.006.jpg
case_images: fig6
case_images: The corresponding flow cytometry (Figure 6) demonstrated clonality with a lambda restricted CD20+/CD10+ population consistent with a low grade B-cell lymphoma with a germinal center phenotype.