Correlation of Internal Echo Findings With the Aggressiveness of Diffuse Large B-Cell Lymphomas: A Case Report

It is well known that diffuse large B-cell lymphomas (DLBCLs) generally have very low internal echoes. We herein report a case of DLBCL presenting with internal high echoes and found that internal high echoes correlate with the less aggressive form of the tumor. A 68-year-old man with a history of sigmoid colon cancer and metastatic liver tumor surgeries was referred to our hospital due to multiple swollen lymph nodes, especially around the abdominal aorta. Positron emission tomography/computed tomography of the target foci showed a maximum standardized uptake value of 23. The soluble interleukin-2 receptor was elevated up to 2763 U/mL. Ultrasound showed that the masses predominantly had internal low echoes; however, there were some masses with punctate internal high echoes in the upper abdomen and these seemed most amenable to surgical removal. The patient, therefore, underwent an excisional biopsy on one of these target nodes. Pathological study of the removed node showed medium-to-large atypical cells diffusely proliferating against mixed sclerotic and edematous backgrounds. In addition, the mass had heterogeneous dense and sparse areas of atypical cells. Immunostaining of the atypical cells showed CD20, CD79a, CD5, and BCL2 positivity, CD10, CD15, CD23, CD30, BCL6, and cyclin D1 negativity, and a Ki-67 labelling index of 70%, leading to the diagnosis of DLBCL. Diagnostic physicians should note that DLBCLs can have internal high echoes when having sparse lymphoma cells against the edematous background.