TITLE:
Unusual Multivisceral Extranodal Involvement of Aggressive B-Cell Lymphoma: A Case Series and Literature Review
AUTHORS:
Boidy Kouakou, Norman Isaac Klébair Kouamé, Ismaël Kamara, Yao Nicaise Atiméré, Affoué N’Guessan Jeanne Ines Kouakou, Ruth Djeket, Hiabba Emmanuela Assohou-Koffi, Atta Yao Emmanuel Kouadio, Kouassi Gustave Koffi
KEYWORDS:
Aggressive B-Cell Lymphoma, Diffuse Large B-Cell Lymphoma, Burkitt Lymphoma, Extranodal Involvement, Multivisceral Involvement, HIV
JOURNAL NAME:
Open Journal of Blood Diseases,
Vol.16 No.3,
October
20,
2026
ABSTRACT: Background: Aggressive B-cell lymphomas may present with extranodal involvement; however, simultaneous involvement of multiple unusual extranodal sites is uncommon and may mimic disseminated solid malignancies, resulting in diagnostic challenges. We report three cases of aggressive B-cell lymphoma with unusual multivisceral extranodal involvement. Case presentation: Three women aged 26, 34, and 28 years presented with advanced aggressive B-cell lymphomas involving multiple extranodal sites. Two patients were living with HIV. Cases 1 and 2 were diagnosed with diffuse large B-cell lymphoma (DLBCL), with germinal center B-cell-like and non-germinal center B-cell-like immunophenotypes, respectively. Case 3 had morphological and cytological findings strongly supportive of Burkitt lymphoma; however, immunohistochemical characterization and MYC rearrangement analysis were unavailable, precluding complete classification according to current WHO-HAEM5/ICC criteria. Extranodal involvement included the pleura, pericardium, liver, stomach, bilateral breasts, kidneys, gallbladder, inferior vena cava, latero-uterine region, and Waldeyer’s ring. Cases 1 and 2 received eight cycles of R-CHOP with prophylactic intrathecal chemotherapy, whereas Case 3 received an LMB02-based regimen and completed two R-COPADM induction courses. At the August 12, 2026 data cut-off, Cases 1 and 2 were in complete remission, with no residual disease on post-treatment computed tomography, and remained under clinical follow-up. Case 3 had completed induction and was awaiting CYM1 consolidation; no formal imaging-based response assessment had yet been performed. Conclusion: Multivisceral extranodal involvement of aggressive B-cell lymphomas may closely mimic metastatic solid malignancies. Early tissue sampling combined with appropriate immunophenotypic characterization is essential for establishing the diagnosis. These cases also highlight the diagnostic challenges encountered when advanced molecular and immunophenotypic investigations are not readily available in resource-limited settings.