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A 51-year-old man with end stage liver disease secondary to hepatitis C underwent liver transplantation. The explanted liver showed cirrhosis and hepatitis. Additionally, the small hilar vessels were filled with large atypical lymphocytes with scant cytoplasm, irregular nuclei, dispersed chromatin and prominent nucleoli (fig 1). The neoplastic cells expressed CD45, CD20, PAX-5 and MUM1 without CD5, CD10 or BCL-6 by immunohistochemistry. A diagnosis of intravascular large B cell lymphoma (IVLBCL) was made.
Staging studies (body CT scan, bone marrow biopsy, peripheral blood flow cytometry, skin survey, and brain MRI) were negative. The patient was asymptomatic and initially followed by observation. A PET scan …