case_images: PMC11792325_01
case_images: Outputs from standard and supplemental examination of a patient with aggressive lymphoma infiltrating the CNS (except histology that could not be performed): (A) morphology of BM infiltrated with lymphoma cells (Burkitt lymphoma-like phenotype); (B) flow cytometric analysis showing clonal infiltration of BM and CSF (malignant lymphoma cells in red, non-B cells in blue); (C) timeline of various therapy administrations and laboratory examinations (time corresponds with sampling, asterisk marks test performed retrospectively). BM- bone marrow, CNS- central nervous system, CSF- cerebrospinal fluid, CT- computed tomography, FC- flow cytometry, NGS- next-generation sequencing; and (D) cytogenetic results of diagnostic BM examination showing complex karyotype by mFISH on the left (47,XY,t(4;9)(q?31.2;p?21),+8,t(8;22)(q24;q11),t(9;13)(p?13;q?14.3),dup(12)(q?q?), der(14)t(14;18)(q32;q21), and IGL and BCL2 rearrangements by FISH on the right (arrows mark chromosomal disruptions).
case_images: 13000_2025_1609_Fig1_HTML.jpg
case_images: PMC11792325_01_13000_2025_1609_Fig1_HTML.jpg
case_images: Fig1
case_images: B-cell lymphoma (Fig. 1A and B). Because of rapid clinical deterioration (leukocytosis 70 x 109/l, creatinine 115 micromol/l, lactate dehydrogenase > 150 ukat/l), thrombocytopenia and a low probability of obtaining additional diagnostic information from BM histology, trephine biopsy was not performed. Intensified chemotherapy included two cycles of R-CHOEP21 (E, etoposide) and two cycles of R-DHAOx (DHAOx, cytosine arabinoside and oxaliplatin) switched due to myelo- and neurotoxicity to one cycle of R-HD-AraC (HD-AraC, high dose cytosine arabinoside) (Fig. 1C). The samples from the time of diagnosis and suspected CNS progression were tested (Fig. 1C). The analysis of diagnostic BM by cytogenetic methods revealed a complex karyotype (CK) with translocation t(14;18)(q32;q21) and variant translocation t(8;22)(q24;q11) (Fig. 1D).