Gray zone lymphoma effectively treated with cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab chemotherapy: A case report

Figure 1 Enhanced computed tomography showing a right cervical mass (A) and multiple low-density lesions in the liver and spleen (B).

Figure 2 Fluorodeoxyglucose positron emission tomography/computed tomography revealed multiple lesions throughout the patient’s body. A: Abnormal lymph node enlargement in the right neck, right clavicular region, and anterior mediastinum; B: Abnormal lymph node enlargement around the hepatic portal region, pancreatic head, and paraaortic region. Multiple nodular lesions in the liver and spleen; C: Multiple bone lesions in the left skull, thoracic and lumbar vertebrae, bilateral ribs, right clavicle, bilateral scapulae, lower end of the sternum, sacrum, bilateral ilia, left pubis, and bilateral femora.

Figure 3 Large lymphoma cells in the biopsied right supraclavicular lymph node. A: Sheet-like growth of atypical and pleomorphic cells and centroblastic cells (× 400). Inset: Fibrosis around the sheets of lymphoma cells (× 20); B: Large, atypical cells with some retracted pale cytoplasm scattered among the inflammatory cells (× 400).

Figure 4 Immunohistochemical staining of lymphoma cells. A: The cells were strongly and uniformly positive for CD20 (× 400); B: Strongly positive for PAX5 (× 400); C: Variably positive for CD30 [weakly positive (C1) or moderately to strongly positive (C2)] (× 400); D: Moderately to strongly positive for MUM1 (× 400); E: OCT2 was strongly positive for large atypical cells (80%); F: BOB1 strongly positive large atypical cells (inserted) were found in small numbers (< 10%).

Figure 5 Programmed cell death protein ligand 1 expression by lymphoma cells. Scattered large lymphoma cells, but not nonlymphoma cells, were strongly positive for programmed cell death protein ligand 1 (clone SP142) (× 200). Insert: Positive staining of the large lymphoma cell membrane was observed (× 400).