A 53-year-old male presents with confusion. progressive weakness. and weight loss. Physical examination reveals bilateral inguinal lymphadenopathy and splenomegaly. Laboratory workup is significant for a leukocyte count of 9LJ.OOO/,LLL. hemoglobin of 7.LJ g/dl. and platelet count of 27.000/,LLL. Creatinine is elevated at 5.7 mg/dl. with no prior history of renal impairment. LDH and uric acid levels are found to be elevated at 1.850 U/L and 13.8 mg/dl. respectively. CT scan of the abdomen reveals massive lymphadenopathy. Flow cytometry of the peripheral blood shows expression of CD19. CD20. and HLA-DR on the surface of the abnormal leukocytes. Peripheral blood smear is shown below.
Of the options listed, what is the most common site of extranodal involvement?
- Spleen
- Lung
- Liver
- Bone
- Cerebrospinal spinal fluid (CSF)
Medicine
A. Extranodal involvement is seen in all cases ofDLBCL presenting in leukemic phase. Ac cording to one study, bone marrow involvement was present in 100% of cases, followed by spleen (62%), lung (41 %), liver (21 %), bone (17%), CSF (14%), and bowel (7%). This is in contrast with ILCL, where extranodal involvement is much less commonly observed (Br J Haematol. 2012;158(5):608, l Clin Oneal. 2007;25(21):3168, Blood. 2007;109(2):478, Br J Haematol. 2004;127(2):173).
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