The patient presented with neck swelling, back pain and constitutional symptoms.

Neck ultrasound and lumbosacral MRI were requested. The ultrasound showed multi-compartmental suspicious matted lymph nodes.

On MRI, a large hepatic mass was discovered that shows restricted diffusion and necrosis along with hepatosplenomegaly, vertebral pathological fracture and bone marrow infiltration.

In correlation with cervical lymphadenopathy, the infiltrative bony findings are highly suggestive of neoplastic infiltration, with splenic and hepatic involvement, mostly related to lymphoma.

The histopathology report after liver trucut biopsy showed:

Diffuse proliferation of atypical lymphocytes with prominent mitotic activity. The atypical cells are positive for CD20 with a proliferation index of about 80%. CD3 and CD30 are negative.

Diagnosis: Non-Hodgkin's lymphoma, diffuse large B cell.

In conclusion, findings are consistent with non-Hodgkin's lymphoma with hepatic involvement (hepatic lymphoma!), cervical lymphadenopathy, hepatosplenomegaly and bone marrow infiltration.