Case 146 – update 1

You have arranged for this lady to have a CT chest/abdomen/pelvis which, apart from thickening of the stomach lining, is unremarkable.

Her final biopsy results are reported as follows:

“There is a diffuse atypical lymphoid infiltrate of medium sized cells with open chromatin. There are numerous plasma cells with distinct cytoplasmic immunoglobulin globules. IHC reveals predominantly B-cells positive for CD20 and CD79a and negative for CD5, IRF4, cyclin D1, CD10, and BCL6. Staining for H. pylori reveals numerous positive organisms. In situ hybridisation for Ig light chains shows lambda-restricted plasma cells. EBV negative.”

What is the diagnosis and what are her treatment options?

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