case_images: PMC10848882_01
case_images: Skeletal survey demonstrated numerous lesions throughout the (A) femur, (B) humerus, and (C) skull.
case_images: cureus-0016-00000051856-i01.jpg
case_images: PMC10848882_01_cureus-0016-00000051856-i01.jpg
case_images: FIG1
case_images: A skeletal survey further demonstrated numerous lesions throughout the bilateral femurs, humerus, and skull (Figure 1).
case_images: Bone marrow flow cytometry.. The bone marrow flow cytometry plots demonstrate an abnormal, clonal B-cell population (red) with intermediate forward scatter, bright expression of CD20 and CD22, and kappa light chain restriction. This population was negative for CD5 and CD10 (not shown) and was admixed with normal polytypic B cells of small size (depicted in yellow). A clonal plasma cell population was not observed.
case_images: cureus-0016-00000051856-i02.jpg
case_images: PMC10848882_01_cureus-0016-00000051856-i02.jpg
case_images: FIG2
case_images: Flow cytometric analysis identified a small clonal population of kappa-restricted CD5- and CD10-negative, intermediate-sized B cells (Figures 2-3).
case_images: Bone marrow core biopsy histology.. (A) The bone marrow core biopsy with aspiration demonstrates moderate hypercellularity with atypical paratrabecular pale areas (hematoxylin and eosin, 40x). (B) This area is composed of fibrosis and a spindled, small-sized lymphoid infiltrate (hematoxylin and eosin, 200x). Immunohistochemical stains for (C) CD3 (100x) and (D) CD20 (100x) demonstrate an atypical CD20(+) B-cell population arranged solely in a paratrabecular location throughout the entire core biopsy, supporting a diagnosis of lymphoma.
case_images: cureus-0016-00000051856-i03.jpg
case_images: PMC10848882_01_cureus-0016-00000051856-i03.jpg
case_images: FIG3
case_images: Flow cytometric analysis identified a small clonal population of kappa-restricted CD5- and CD10-negative, intermediate-sized B cells (Figures 2-3).
case_images: H&E (100x) biopsy of the right femur lytic lesion.. The histologic section demonstrates an atypical lymphoid infiltrate comprising intermediate- to large-sized CD10-negative B lymphocytes expressing BCL6 and MUM-1, consistent with diffuse large B-cell lymphoma (DLBCL), activated B-cell type.. H&E, hematoxylin and eosin
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case_images: PMC10848882_01_cureus-0016-00000051856-i04.jpg
case_images: FIG4
case_images: A subsequent femur biopsy of a lytic lesion demonstrated DLBCL, activated B-cell type (Figure 4).