case_images: PMC9806947_01
case_images: Computed tomography (CT).. (A) CT chest showing multiple enlarged axillary lymph nodes (red circle). (B) CT abdomen showing hepatosplenomegaly with minimal ascites (red arrow spleen, yellow arrow liver). (C) CT neck showing multiple prominent upper neck lymph nodes (red circle cervical lymph node).
case_images: cureus-0015-00000033239-i01.jpg
case_images: PMC9806947_01_cureus-0015-00000033239-i01.jpg
case_images: FIG1
case_images: Body computed tomography (CT) was conducted and showed mainly supra- and infra-diaphragmatic lymphadenopathy, splenomegaly, and a suspicious left adrenal gland lesion (Figures 1A-1C).
case_images: Lymph node (LN) biopsy.. (A) LN, hematoxylin and eosin (20x): sheets of pleomorphic, intermediate-to-large lymphocytes with irregular nuclear borders, vesicular chromatin, and prominent nucleoli. (B) CD20, high-power, shows strong and diffuse positivity. (C) CD5 is negative in neoplastic lymphocytes and positive in background bystander T cells. (D) Cyclin D1, high-power, shows strong, diffuse nuclear expression. (E) Ki67, high proliferative rate. (F) CD21, follicular dendritic cell meshwork. (H) CD23 positive in follicular dendritic cell meshwork and negative in neoplastic cells. (I) CD10 negative in neoplastic lymphocytes but positive in few residual reactive germinal centers. (J) BCL-6, positive in reactive germinal center and negative in neoplastic cells.
case_images: cureus-0015-00000033239-i02.jpg
case_images: PMC9806947_01_cureus-0015-00000033239-i02.jpg
case_images: FIG2
case_images: The patient underwent an inguinal lymph node biopsy (Figure 2A) which showed an architecturally effaced lymph node by vague nodules filled with sheets of pleomorphic intermediate-to-large lymphocytes with irregular nuclear borders, vesicular chromatin, and prominent nucleoli. Overall, 60% of the cells had TP53 mutation (Figures 2B-2J).
case_images: Bone marrow (BM) biopsy.. (A) BM hematoxylin and eosin, low power: effacement by a diffuse interstitial lymphoid infiltrate. (B) Mantle BM immunostains, CD20. (C) Mantle BM immunostains, cyclin D1.
case_images: cureus-0015-00000033239-i03.jpg
case_images: PMC9806947_01_cureus-0015-00000033239-i03.jpg
case_images: FIG3
case_images: Trilineage hematopoiesis was markedly diminished (Figure 3A). The neoplastic lymphocytes were positive for CD20 and cyclin D1 and negative for all the other markers utilized, including CD5 and 138 (Figures 3B, 3C).