case_images: PMC9925213_01
case_images: Abdominal ultrasonography. Multiple variable-sized hepatic complex cystic focal lesions
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case_images: PMC9925213_01_43066_2023_240_Fig1_HTML.jpg
case_images: Fig1
case_images: He sought medical advice, and his doctor asked for abdominal ultrasonography (Fig. 1).
case_images: Whole-body PET-CT. Variable-sized metabolically active bilobar focal hepatic lesions in addition to active marrow-based osseous lesions at L1 vertebral body and proximal RT femoral shaft
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case_images: PMC9925213_01_43066_2023_240_Fig2_HTML.jpg
case_images: Fig2
case_images: The suggested provisional diagnosis includes lymphomas vs metastatic multifocal primary hepatic malignancy (Fig. 2).
case_images: Abdominal MRI. Heterogeneous low T1 and higher T2 signal with some element of diffusion restriction along its periphery
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case_images: PMC9925213_01_43066_2023_240_Fig3_HTML.jpg
case_images: Fig3
case_images: He considered metastatic vs multifocal HCC (Fig. 3).
case_images: Histopathology and immunohistochemical staining. Diffuse sheets of large lymphoid cells with large irregular nuclei, focally showing prominent nucleoli and many nuclear debris (H&E x 400), diffusely positive for CD20 (inset, immunostain x 100)
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case_images: PMC9925213_01_43066_2023_240_Fig4_HTML.jpg
case_images: Fig4
case_images: The findings are consistent with large B-cell lymphoma and post germinal center origin (activated B-cell type) (Fig. 4).
case_images: Posttreatment whole-body PET-CT. Morphological regression of the metabolically inert multiple hepatic focal lesions with no newly developed metabolically active lesions
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case_images: PMC9925213_01_43066_2023_240_Fig5_HTML.jpg
case_images: Fig5
case_images: Three months after, the chemotherapy sessions were fulfilled; a follow-up PET-CT was done and showed further morphological regression of the metabolically inert multiple hepatic focal lesions with no newly developed metabolically active lesions all over the body, indicating sustained complete metabolic disease remission (Fig. 5).