A 56-year-old man with history of chronic hepatitis C and low-risk prostate cancer presents with periumbilical pain for the last week.
1.There is conglomerate retroperitoneal lymphadenopathy.
2.The spleen is nodular in contour.
3.There is an occlusive inferior vena caval thrombus.
4.There is a rind of hypodense tissue around the visualized upper renal poles.
5.There are hypodense hepatic lesions.
6.The attenuation pattern of the spleen is most likely related to which of the following?
Physiologic enhancement 正常生理性强化
Chronic post-traumatic changes 外伤后慢性改变
Multifocal hemangiomas 多发血管瘤
Neoplastic involvement 肿瘤侵犯
7.Which of the following is the most likely diagnosis?
Metastatic hepatocellular carcinoma 转移性肝细胞型肝癌
Metastatic prostate cancer 转移性前列腺癌
Abdominal tuberculosis 腹部结核
Reactive lymphadenopathy from inflammatory bowel disease 肠道炎性病变反应性淋巴结肿大
8.The majority of lymphomas originate from which the following lymphocyte types?
9.Mesenteric lymphadenopathy is more common in which of the following?
10.Infection with the hepatitis C virus (HCV) has been associated with increased risk for non-Hodgkin\’s lymphoma.
11.Patients with chronic hepatitis C have a higher risk of developing lymphoma than hepatocellular carcinoma.
Findings and Diagnosis
Contrast-enhanced CT demonstrates markedly enlarged, hypoattenuating conglomerate upper abdominal retroperitoneal and mesenteric lymphadenopathy (best demonstrated on coronal images). There are multifocal hypodense lesions throughout the spleen, which is enlarged and nodular in contour, reflecting lymphomatous involvement. There are a few small hypodense lesions in the liver, the most prominent in segment VI, which were incompletely characterized, but favored to represent hepatic lymphomatous involvement given the lymphadenopathy and splenic involvement. The patient was subsequently confirmed to have diffuse large B-cell lymphoma.
Abnormal proliferation of mature lymphocyte population.
Spectrum of disease or multiple subtypes: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype and can occur as primary disease or transformation from indolent lymphoma.
Clinical association with various viral infections is well-described, including Epstein-Barr virus (EBV), human T-lymphotropic virus 1 (HTVL-1), human immunodeficiency virus (HIV), hepatitis C virus (HCV), and herpes simplex virus (HSV)