case_images: PMC5448865_01
case_images: Bone marrow aspirate showing abnormal histiocytes and prominent phagocytosis of red cells, neutrophils, and platelets, compatible with hemophagocytosis under Liu's stain with 100x power field.
case_images: 10.1177_2050313X17709190-fig1.jpg
case_images: PMC5448865_01_10.1177_2050313X17709190-fig1.jpg
case_images: fig1-2050313X17709190
case_images: Bone marrow smear showed severe hemophagocytosis (Figure 1) and no abnormal population or light chain restriction indicated by flow cytometry.
case_images: (a) Abdominal ultrasonography showing multiple hypoechoic lesions up to 2.07 cm on both lobes, (b) abdominal computed tomography showing ill-defined poor enhancing nodular lesions (yellow arrow) on both hepatic lobes, (c) the pathology of liver tumor specimen under H&E stain with 200x power field, and (d) these atypical cells were positive for CD20.
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case_images: PMC5448865_01_10.1177_2050313X17709190-fig2.jpg
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case_images: Moreover, abdominal ultrasonography disclosed multiple hypoechoic lesions up to 2 cm on both lobes (Figure 2(a)). Abdominal computed tomography (CT) showed multiple ill-defined poor enhancing nodular lesions on both hepatic lobes (Figure 2(b)). B cell lymphoma (Figure 2(c)), identifying lymphoma cells CD20+/CD10-/BCL-6+/BCL-2+/cyclin D1-/EBER- (Figure 2(d)). Because of old age, multiple comorbidities, and the fragile clinical status of the present case, we initiated chemotherapy with rituximab and bendamustine (rituximab 375 mg/m2 for 1 day; bendamustine 90 mg/m2 for 2 days).
case_images: Small hypovascular hepatic lesions (yellow arrow) decreased in size compared with a prior study (Figure 2(b)) after the second cycle of chemotherapy.
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case_images: After the second cycle of chemotherapy, abdominal CT revealed excellent treatment response with much smaller hypovascular lesions at both hepatic lobes compared with the prior study (Figure 3).