Indian Journal of Medical Research

CLINICAL IMAGE
Year
: 2019  |  Volume : 150  |  Issue : 3  |  Page : 310--311

Diffuse large B-cell lymphoma presenting as shoulder swelling


YS Sarma, M Sriharibabu 
 Department of Medicine, GSL Medical College & General Hospital, Rajahmundry 533 296, Andhra Pradesh, India

Correspondence Address:
M Sriharibabu
Department of Medicine, GSL Medical College & General Hospital, Rajahmundry 533 296, Andhra Pradesh
India




How to cite this article:
Sarma Y S, Sriharibabu M. Diffuse large B-cell lymphoma presenting as shoulder swelling.Indian J Med Res 2019;150:310-311


How to cite this URL:
Sarma Y S, Sriharibabu M. Diffuse large B-cell lymphoma presenting as shoulder swelling. Indian J Med Res [serial online] 2019 [cited 2019 Dec 8 ];150:310-311
Available from: http://www.ijmr.org.in/text.asp?2019/150/3/310/270629


Full Text

A 53 yr old male† diabetic patient presented to the Oncology division of Medicine department of GSL Medical College and General Hospital, Rajahmundry, India, in June 2017 with a swelling of three months duration over the posterior aspect of the right shoulder [Figure 1]A. The swelling was associated with pain and limitation of shoulder movements. His general physical examination was normal, except for right axillary and supraclavicular lymphadenopathy. On clinical examination, the diagnosis was soft-tissue sarcoma/osteosarcoma/Ewing's sarcoma. Radiograph of the right shoulder revealed a large swelling on the posterior aspect obscuring the lateral border of the scapula. Computed tomography (CT) imaging of the right shoulder revealed a large soft-tissue mass with permeative destruction of the right scapula and enlarged axillary and pectoral lymph nodes [Figure 2]A. Peripheral smear examination and bone marrow study were normal. CT imaging of the abdomen and chest revealed no lymphadenopathy. Histopathological examination of the lymphoid tissue revealed diffuse proliferation of large lymphoid cells which are round to polygonal with single prominent eosinophilic nucleolus and ample amphophilic cytoplasm suggestive of diffuse large B-cell lymphoma (DLBCL). Immunostaining of sections of the axillary lymph node for CD45 and CD20 was positive, suggesting non-Hodgkin's lymphoma (NHL) of diffuse large B-cell subtype [Figure 3]A and [Figure 3]B. Hence, the final diagnosis of NHL diffuse large B-cell subtype stage IIAX was made. Six cycles of immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone regimen were given followed by involved-field radiotherapy with 6 MV (megavoltage) photon beams at a dose of 39.5 Gy in 22 fractions. There was a significant reduction in the size of the tumour mass [Figure 1]B and [Figure 2]B with improvement in shoulder pain and movements at 18 months of follow up.{Figure 1}{Figure 2}s{Figure 3}

Conflicts of Interest: None.