Abstract
Granulomatous inflammation has been reported to be associated with Hodgkin and non-Hodgkin lymphomas. Here, we report a case of recurrent diffuse large B-cell lymphoma (DLBCL) with extensive granulomatous inflammation that was initially misdiagnosed as granulomatous lymphadenitis. In 2019, a 75-year-old Caucasian male presented to our hospital with an enlarged right supraclavicular lymph node. He had a medical history of prostate cancer (in 2004), DLBCL (initially diagnosed in 2009), and rectal adenocarcinoma (in 2017), all of which responded well to treatment. In 2018, the patient had experienced right axillary adenopathy, weight loss, and intermittent night sweats. An excisional biopsy of a right axillary lymph node, performed at another institution, was diagnosed as granulomatous lymphadenitis. In 2019, at our hospital, an excisional biopsy of a right supraclavicular lymph node showed DLBCL in a background of granulomatous inflammation. A review of the prior right axillary lymph node biopsy also showed DLBCL with a background of extensive granulomatous inflammation. Chemotherapy was initiated and the patient’s follow-up showed a good response. We report this case to raise awareness that granulomatous inflammation may obscure the diagnosis of some neoplasms, such as DLBCL, which are less commonly known to have granulomatous inflammation. This may result in delayed treatment and may ultimately affect outcomes.
Highlights
Diffuse large B-cell lymphoma-not otherwise specified (DLBCL-NOS) is the most common subtype of non-Hodgkin lymphoma (NHL) and has an incidence rate of 6.3 per 100,000 in the USA
Granulomatous inflammation has been reported to be associated with Hodgkin and non-Hodgkin lymphomas
We report a case of recurrent diffuse large B-cell lymphoma (DLBCL) with extensive granulomatous inflammation that was initially misdiagnosed as granulomatous lymphadenitis
Summary
Diffuse large B-cell lymphoma-not otherwise specified (DLBCL-NOS) (referred to as DLBCL in this study) is the most common subtype of non-Hodgkin lymphoma (NHL) and has an incidence rate of 6.3 per 100,000 in the USA. A positron emission tomography (PET) scan showed extensive fluorodeoxyglucose (FDG)-avid lymphadenopathy above and below the diaphragm, stage IV, with biopsy-proven bone marrow involvement He was treated with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone with complete response. In January 2019, a biopsy of the patient’s enlarged right supraclavicular lymph node was performed, which showed DLBCL in a background of granulomatous inflammation (Figure 2). The prior right axillary lymph node biopsy (2018) was reviewed at our institution and showed DLBCL with a background of extensive granulomatous inflammation. A follow-up PET scan in April 2019 showed minimal partial response, and a biopsy of a PETavid right axillary lesion confirmed residual DLBCL with extensive granulomatous inflammation. A follow-up PET/CT in July 2020 showed a very good response
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