Clinicopathological and Imaging Characteristics of EBV Positive Inflammatory Follicular Dendritic Cell Sarcoma

Clinicopathological and Imaging Characteristics of EBV Positive Inflammatory Follicular Dendritic Cell Sarcoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinicopathological and Imaging Characteristics of EBV Positive Inflammatory Follicular Dendritic Cell Sarcoma Jie Zhao, Kun Wang, Xiaoying Liu, Xuemei Zeng, Yanchun Li, Yuli Zeng, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4891123/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective EBV-positive inflammatory follicular dendritic cell sarcoma (EBV + inflammatory FDCS) is a rare tumor that has been less systematically studied. This study aims to improve the understanding of EBV + inflammatory FDCS by analyzing radiological imaging data and clinicopathological features. Methods A retrospective analysis was performed on twelve patients with EBV + inflammatory FDCS confirmed pathologically. Ten patients underwent computed tomography (CT) scans, six underwent magnetic resonance imaging (MRI) scans, and four patients underwent CT and MRI scans simultaneously. Results Twelve patients (six in the liver and six in the spleen) had clinically asymptomatic or asymptomatic, and six cases were found on physical examination. Pathologically, the tumor cells dispersed in a background of inflammatory cells. All cases showed positive expression of at least one follicular dendritic cell (FDC) marker and EBV. On unenhanced CT images, nine cases of EBV + inflammatory FDCS presented as well-defined iso-or hypodense masses, and one liver case had an irregularly shaped lesion with unclear borders. All cases showed iso-or hypodensity signals on T1WI and mixed signals on T2WI. The hepatic lesions showed marked enhancement in arterial phase and diminished enhancement in portal vein phase and delayed phase, whereas the splenic lesions showed mild enhancement in arterial phase and continued enhancement in portal vein phase and delayed phase . Conclusion EBV + inflammatory FDCS is a rarely low-grade malignant tumor, which exists the possibility of local lymph node metastasis and recurrence. Therefore, the preoperative diagnosis is expected to improve by carefully analyzing the imaging features and clinical characteristics of the patients. EBV positive inflammatory follicular dendritic cell sarcoma computed tomography magnetic resonance imaging ultrasonography Figures Figure 1 Figure 2 Introduction Infammatory pseudotumor-like follicular dendritic cell sarcomais a rare, Epstein-Barr virus (EBV)–associated neoplasm, characterized by spindly tumor cells dispersed in a background of small lymphocytes and plasma cells. In 2022, the World Health Organization has named infammatory pseudotumor-like follicular dendritic cell sarcomais as EBV positive inflammatory follicular dendritic cell sarcoma (EBV + inflammatory FDCS). EBV + inflammatory FDCS is inert in biological behavior, and surgical resection can achieve good long-term efficacy [ 1 ] . Therefore, accurate diagnosis before surgery is very important. To our knowledge, EBV + inflammatory FDCS has mainly been reported in case studies analyzing clinicopathological features with only a little previous literatures incorporating imaging findings. The purpose of this study is to improve the diagnosis of EBV + inflammatory FDCS and provide a basis for clinical diagnosis by analyzing the radiological and clinicopathological features of twelve cases with EBV + inflammatory FDCS from Hunan Provincial People’s Hospital /The First Affiliated Hospital of Hunan Normal University. Methods and materials Subjects Twelve patients with EBV + inflammatory FDCS confirmed by surgical pathology were enrolled from January 2018 and June 2023. As shown in Table 1 , the patients included three males and nine females, with an average age of 53-year-old (rang, 31–71years). Six patients (50.0%) presented with abdominal distention or abdominal pain or fever, and six patients (50.0%) were incidentally found during health checkups. Serum tumor marker examinations including α-fetoprotein (AFP) , carcinoembryonic antigen (CEA) , carbohydrate antigen 199 (CA199) , and carbohydrate antigen 125 (CA125) revealed that twelve patients had no significant abnormalities. Hepatitis B virus surface antigen was negative in twelve patients. Preoperative images and postoperative pathological data of all patients were reviewed. Follow-up data were obtained by telephone. Informed consent was obtained from patients upon research authorization by the Medical Ethics Committee of Hunan Provincial People Hospital (IRB Approval No.[2024]-72). Table 1 Clinical characteristics of EBV + inflammatory FDCS patients (n = 12) Case no Sex Age (years) Location Symptoms Examination method Initial Diagnosis Treatment outcome 1 F 56 Spleen No CT and MRI SANT Surgical excision Tumor-free survival 2 F 35 Liver (S6) No MRI, ultrasound HCC Surgical excision Tumor-free survival 3 F 71 Spleen Pain in the right upper abdomen CT, ultrasound Spleen space -occupying lesions Surgical excision Tumor-free survival 4 F 31 Liver (right lobe) Intermittent fever MRI, ultrasound HCC Surgical excision Tumor-free survival 5 M 48 Liver (right lobe) No CT, ultrasound HCC Surgical excision Recurrence, survival with tumor 6 F 65 Spleen No CT Dysplasia Surgical excision Tumor-free survival 7 F 61 Spleen No CT and MRI ultrasound Spleen space -occupying lesions Surgical excision Tumor-free survival 8 M 66 Spleen Pain in the left upper abdomen CT and MRI ultrasound SANT Surgical excision Tumor-free survival 9 M 32 Liver (S6) Pain in the right upper abdomen CT, ultrasound HCC Surgical excision Tumor-free survival 10 F 57 Liver (S8) Pain in the right upper abdomen CT, ultrasound Liver space -occupying lesions Surgical excision Tumor-free survival 11 F 59 Spleen No CT SANT Surgical excision Tumor-free survival 12 F 60 Liver (S7) Pain in the abdomen CT and MRI ultrasound ICC Surgical excision Tumor-free survival Note—F = female, M = male, HCC = hepatocellular carcinoma, ICC = intrahepatic cholangiocarcinoma, SANT = sclerosing angiomatoid nodular transformation of the soleen. Image Acquisition Patients underwent the abdominal CT or MRI examinations. CT was performed in ten patients, MRI in six patients, both CT and MRI in four patients. The CT examinations were performed using the following two systems: Philips Brilliance iCT (Netherlands) (n = 4) or Neusoft NeuViz 64i CT (Shenyang, China) (n = 6). The acquisition parameters were as follows: tube voltage of 120 kVp, tube current of165–375 mA determined by automatic tube current adjustment, slice thickness of 5 mm, and pitch of 0.984:1. Contrast-enhanced CT was performed after a bolus intravenous injection of 1.5 mL/kg of a nonionic contrast agent (350mgI/mL, 100mL, Shanghai General Electric Pharmaceutical Co., Ltd, Shanghai, China) through the anterior cubital vein by dual cylinder high-pressure injector (Ulrich, Germany) at a rate of 3.0–4.0mL/s. After injection of contrast agent, the arterial phase (AP)and portal vein phase (PP) and delayed phase (DP)scanning were performed at a delay of 25–30s, 60–65s and 120s, respectively. MRI was performed using a Siemens Magnetom Trio A Tim System 3.0t MR scanner (Germany) with a torso coil. The routine MRI protocol was performed and consists of the following MRI sequences: a T2-weighted imaging (T2WI) fast spin-echo or turbo spin-echo sequence, a fat-suppressed respiratory-triggered heavily T2WI sequence, and a T1-weighted imaging (T1WI) gradient-recalled echo sequence with and without chemically selective fat suppression. diffusion-weighted imaging(DWI)was performed using a respiratory-triggered single-shot echo-planar sequence with b values of 0 and 800 s/mm2. Contrast-enhanced MRI was performed with dimeglumine gadopentetate (12mL, Guangzhou Kangchen Pharmaceutical Co., Ltd, Guangzhou, China) was intravenously injected through the anterior cubital vein by dual cylinder high-pressure injector, the dose of contrast agent was about 20–24mL(0.4mL/kg), and the flow rate was 2.0 ~ 3.0mL/s. Contrast enhanced images were obtained with a scanning delay of 20 ~ 25s (AP) and 60–65s (PP) and 120s (DP) after the start of contrast agent injection. Nine of the twelve patients underwent ultrasound imaging using the Philips S2000 or Toshiba Aplio500 (Toshiba, Tokyo, Japan) system, and one of them underwent contrast-enhanced ultrasound. The frequency of the convex array probe is 3.5-5.0 MHz. Image Analysis Two associate professors read the images independently, and the resulting quantitative data were averaged. If the qualitative data were inconsistent, the two radiologists read the images again and reached a verbal consensus. Main parameters include lesion site (accurate to segment), number (single or multiple), size (maximum diameter(cm), accurate to one decimal point), shape (round, oval, irregular or lobulated), margin (clear or unclear, capsule or not), density/signal (homogeneous or heterogeneous, calcification, hemorrhage, cystic/necrosis), enhanced images (enhanced mode, degree), adjacent tissues and metastasis (invasion of adjacent viscera, vascular embolus, lymph node, metastasis). Ultrasonography analysis: Two associate professors read the images independently and the resulting quantitative data were averaged. If the qualitative data did not agree, the two sonographers would read the images again and reach a verbal consensus. The main parameters included: lesion site, number, size, shape, margins, internal echoes, color doppler flow, enhancement. Pathologic Evaluation In all twelve cases, the tumors were resected, and the tissue samples were examined using hematoxylin and eosin (HE) staining as well as immunohistochemical EnVision staining. The antibodies that were used are listed in Table 2 . Two pathologists with 18 years of experience analyzed the histopathologic specimens after surgery. Appropriate positive and negative controls were evaluated simultaneously. In situ hybridization for Epstein–Barr virus (EBV)-encoded RNA (EBER) was performed in the twelve cases using an EBV probe in situ hybridization kit (Novocastra, Newcastle upon Tyne, United Kingdom). The manufacturer’s instructions were followed with no modification, and a known positive control was used to ascertain the sensitivity of the assay. Table 2 Antibodies used for immunostaining Antibodies Source Clonality Dilution pretreatment CD21 Maixin Monoclonal ready-to-use HT CD35 Maixin Monoclonal ready-to-use HT CD23 Maixin Monoclonal ready-to-use HT CD30 Maixin Monoclonal ready-to-use HT CD34 Maixin Monoclonal ready-to-use HT S-100 Maixin Monoclonal ready-to-use HT Desmin Maixin Monoclonal ready-to-use HT ALK Maixin Monoclonal ready-to-use HT SMA Maixin Monoclonal ready-to-use HT CD68 Maixin Monoclonal ready-to-use HT CD1a Maixin Monoclonal ready-to-use HT CD20 Maixin Monoclonal ready-to-use HT CD3 Maixin Monoclonal ready-to-use HT CK-P Maixin Monoclonal ready-to-use HT HT High-temperature repair 20min in Titan Instrument DNS Repair solution Results Surgical Method All patients underwent surgical excision. Two liver case hepatic segments (S6) resection; hepatic segments (S7) performed in one liver case; hepatic segments (S8) performed in one liver case; hepatic right lobectomy resection in two liver case, and the lymph node dissection was performed in one case. All six spleen cases underwent splenectomy. No tumor tissue was found at the cutting edge of any of the pathologic specimens. Ultrasonography Findings As shown in Table 3 and Figs. 1 – 2 . Six patients with hepatic lesions and four patients with splenic lesions underwent ultrasonography examination. One patient had two hepatic lesions and the remaining nine patients had single lesions. Ten lesions were regular or lobulated with well-defined borders (maximal diameters range: 1.4 to 10.6 cm), and only one hepatic lesion was irregular shape with ill-defined border (maximum diameter:10.9 cm). Eight lesions showed uneven internal echoes with peripheral hypoechoic or hyperechoic halo in three hepatic lesions and even internal echoes in three lesions. Color Doppler flow imaging showed punctate or striated flow signals within eight lesions, in which peripheral circumferential flow signals were seen in three hepatic lesions and two splenic lesions. Only one patient with hepatic lesion underwent contrast-enhanced ultrasonography, which showed rapid hyperenhancement in AP and hypoenhancement in PP and DP. Table 3 Preoperative US Findings of Eleven Patients with EBV + inflammatory FDCS Case No. Site Number Maximum Diameter (cm) Shape Margins internal echo CDFI Enhancement Pattern 1 Liver (S6) 1 1.8 regular clear even internal echoes NA Rapid high enhancement AP, low enhancement in PP and DP 2 Liver (right lobe) 2 3.8 and 2.1 regular clear low uneven internal echoes and peripheral ring hyperechoic bands flow signals around the tumor None 3 Liver (right lobe) 1 10.9 irregular unclear uneven internal echoes rich flow signals within the tumor None 4 Liver (S6) 1 5.6 regular clear slightly high even internal echoes, and peripheral hypoechoic halo punctate flow signals within and around the tumor None 5 Liver (S8) 1 1.4 regular clear even internal echoes NA None 6 Liver (S7) 1 5.4 regular clear low uneven internal echoes, and peripheral hypoechoic halo punctate flow signals within tumor None 6 Spleen 1 6.1 regular clear low uneven internal echoes punctate flow signals within the tumor None 7 Spleen 1 7.2 regular clear low uneven internal echoes NA None 8 Spleen 1 10.6 lobulated clear low uneven internal echoes punctate or striated flow signals within and around the tumor None 9 Spleen 1 4.4 regular clear low uneven internal echoes flow signals within and around the tumor None Note— NA = not available. CDFI = color doppler flow. CT Findings As shown in Table 4 and Figs. 1 – 2 , the imaging characteristics of EBV + inflammatory FDCS differed slightly between the liver and spleen. Four liver cases and six spleen cases underwent CT examination. Nine cases showed heterogeneous hypodensities with rounded or lobulated borders on unenhanced CT, with multiple punctate foci of calcification within one splenic lesion. Only one hepatic lesion had an irregular shape with ill-defined accompanied by multiple lymph node metastases in the portahepatric area, and the diameter of largest lymph node was approximately 3.5 cm. On enhancement scanning, all four hepatic lesions showed significant enhancement in AP, decreased enhancement in PP and DP. In these four hepatic lesions, one hepatic lesion showed "fast in -fast washout" with nonenhancement necrosis area in the lesion; and one hepatic lesion showed striated foci of relative hypoenhancement in the center of the lesion in AP, and the extent of relative hypoenhancement in the center was smaller than before in PP and DP. All six splenic lesions showed mild to moderate enhancement in AP and continued enhancement in PP and DP. Among the 6 splenic lesions, four lesions showed patches of necrosis without enhancement, and one lesion showed irregular peripheral enhancement. Two liver cases were misdiagnosed as HCC, one liver case was misdiagnosed as ICC; three spleen cases were misdiagnosed as sclerosing angiomatous nodular transformations (SANT), and one spleen case was misdiagnosed as a misshapen tumor or hemangioma. Table 4 Preoperative CT Findings of Eleven Patients with EBV + inflammatory FDCS Case No. site Number Maximum Diameter (cm) Shape No-contrast Arterial phase Portal phase and delayed phase Dynamic enhancement pattern 1 Liver (right lobe) 1 10.9 I Huge ill-defined heterogeneous hypodensity marked heterogeneous enhancement with necrosis without enhancement Enhancement attenuation fast in -fast washout 2 Liver (S6) 1 5.6 O Well-defined heterogeneous hypodensity marked enhancement with relatively low enhancement focus in the center Enhancement attenuation and relative smaller low enhancement extent in the center than before fast in -fast washout 3 Liver (S8) 1 1.4 O Well-defined heterogeneous hypodensity marked enhancement Enhancement attenuation fast in -fast washout a 4 Liver (S7) 1 5.4 O Well-defined heterogeneous hypodensity heterogeneous enhancement Enhancement attenuation a 5 Spleen 1 8.1 O Well-defined heterogeneous hypodensity Heterogeneous mild enhancement marked heterogeneous enhancement with patchy necrosis without enhancement Heterogeneous sustained enhancement 6 Spleen 1 6.1 O Well-defined heterogeneous hypodensity Patchy marked enhancement Progressive enhancement with some non-enhancement hypointense foci Heterogeneous sustained enhancement 7 Spleen 1 5.1 O Well-defined heterogeneous hypodensity Uneven hypoenhancement Progressive enhancement with patchy non-enhancement foci Heterogeneous sustained enhancement a 8 Spleen 1 7.2 O Well-defined heterogeneous hypodensity Irregular peripheral enhancement Irregular peripheral enhancement Heterogeneous sustained enhancement a 9 Spleen 1 10.6 L Well-defined heterogeneous hypodensity with multiple punctate calcifications Mild enhancement Progressive mild enhancement Heterogeneous sustained enhancement 10 Spleen 1 4.4 O Well-defined heterogeneous iso-low density Mild enhancement Progressive mild enhancement with some non-enhancement hypointense foci Heterogeneous sustained enhancement Note—O = oval, L = lobulated, I = irregular. a = Cases 4, 5, 8 and 9 had both CT and MRI scans. MRI Findings As shown in Table 5 and Figs. 1 – 2 , three liver cases underwent MRI examination, which revealed four well-defined quasi-circular lesions, one case had two lesions (maximum diameters: 2.1 cm and 3.8 cm, respectively) and the other two cases had one lesion each (maximum diameter: 1.8 cm and 3.8 cm, respectively). All four liver lesions showed mild low signals on T1WI and mild high signals on T2WI, and exhibited high signal on DWI. The two liver cases were markedly enhanced in AP, with clearing changes observed in the venous phase and low uptake changes observed in the hepatobiliary-specific phase (HSP) . The other two liver lesions showed mild enhancement with low uptake changes in the HSP. The three spleen cases underwent MRI examination, and all had single lesions (maximum diameters: 7.2 cm, 10.5 cm, and 10.6 cm, respectively) with well-defined. All three splenic lesions showed iso-or low signals on T1WI and mixed signals on T2WI. The splenic lesions showed heterogeneous mild enhancement in AP and progressive enhancement in PP and DP with irregular non-enhancing areas within one lesion and irregular peripheral enhancement in one case. Table 5 Preoperative MRI Findings of Eleven Patients with EBV + inflammatory FDCS Case No. site Number Maximum Diameter (cm) Shape No-contrast Arterial phase Portal phase and delayed phase Hepatobiliary phas Dynamic enhancement pattern 1 Liver (S6) 1 1.8 O Well-defined, slightly longer T1 signal and slightly longer T2 signal, DWI high signal, corresponding ADC value reduced. marked heterogeneous enhancement Clearance changes occurred in venous phase Low uptake rate fast in -fast washout 2 Liver (S6) 2 3.8 and 2.1 O Well-defined, long T1 and slightly longer T2, No obvious enhancement Mild enhancement Low uptake rate Heterogeneous sustained enhancement a 3 Liver (S7) 1 5.4 O Well-defined, long T1 signal and long T2 signal, DWI high signal, corresponding ADC value reduced. heterogeneous enhancement Enhancement attenuation,Clearance changes Low uptake rate a 4 Spleen 1 8.1 O Well-defined, slightly longer T1 and slightly longer T2, (mixed central signals) heterogeneous mild enhancement Progressive enhancement No Heterogeneous sustained enhancement a 5 Spleen 1 7.2 O Well-defined Irregular peripheral enhancement Progressive irregular peripheral enhancement No Heterogeneous sustained enhancement a 6 Spleen 1 10.6 L Well-defined T1WI slightly longer signal and T2 mixed signal heterogeneous mild enhancement Progressive enhancement No Heterogeneous sustained enhancement Note—O = oval, L = lobulated. a = Cases3, 4, 5 and 6 had both CT and MRI scans. Pathology results As shown in Fig. 1 – 2 , the pathologic features of EBV + inflammatory FDCS in the liver and spleen were very similar. Macroscopically, the masses were round or oval, solid, grayish-white or grayish-red on section, with well-defined borders, and visible fibrous pseudocapsules extruding into the surrounding tissues. necrosis was present in four cases of larger lesions, and hemorrhage was present in one case. Histological examination showed that the tumor cells were dispersed or arranged in bundles among prominent lymphocytes and plasma cells, with granulomatous changes in two of the splenic cases. Tumor cells were spindle-shaped with indistinct borders and abundant reddish cytoplasm. The nuclei were elongated and vesicular, and the nucleoli were small and obvious. Nuclear division was rare, and multinucleated giant cells were seen in some cases. Immunophenotypically, CD21, CD23 and CD35 were expressed in varying degrees in all twelve cases. By in situ hybridization analysis, all cases were positive for EBER. Discussion EBV + inflammatory FDCS was first reported in 2001 by CHEUK et al [ 2 ] . Its histopathology is different from classical FDCS and is closely related to EBV infection. Compared with classical FDCS, EBV + inflammatory FDCS is more frequently observed in adult female patients, and our study is similar to previous findings[1].The majority of patients were clinically asymptomatic or asymptomatic, in our study population, there were no significant typical symptoms other than those of abdominal discomfort and fever, in addition, the levels of serum tumour markers AFP, CEA, CA199 and CA125 observed in our study were within the normal range, which is consistent with previously reported results [ 3 ] . EBV + inflammatory FDCS is an inert sarcoma, and surgical resection is the first choice of treatment. For patients with tumor recurrence or those who cannot be treated by surgery, chemotherapy or radiotherapy can be administere [ 4 – 7 ] . Among the twelve patients, only one liver patient with hilar lymph node metastasis recurred more than two years after the first surgical resection, underwent a second surgery and four courses of chemotherapy, and now coexists with the tumor. This suggests that although EBV + inflammatory FDCS is low-grade malignant, local lymph node metastasis and recurrence are still possible. The diagnosis of EBV + inflammatory FDCS is based on variable numbers of tumor cells in a background of severe inflammation, coupled with supportive immunohistochemistry and is associated with the Epstein–Barr virus, and the best available immunohistochemical markers for EBV + inflammatory FDCS are CD21, CD23 and CD35 [2; 8] . All patients in our cohort were positive for at least one FDC marker (CD21, CD35, CD23) and the Epstein–Barr encoding region, so the diagnosis of EBV + inflammatory FDCS was clear. To date, the imaging findings of EBV + inflammatory FDCS are rarely reported, with most imaging reports coming from individual cases or small cohorts [ 9 – 11 ] . In our study, we found that EBV + inflammatory FDCS had nonspecific findings on unenhanced ultrasonography, making it difficult to distinguish from other tumours [12; 13] . Only one liver patient underwent CEUS in this study, which showed rapid hyper-enhancement in the arterial phase and hypo-enhancement in the portal and delayed phases, which was consistent with MRI finding. On CT and MRI, intrahepatic and splenic tumours are usually homogeneously or heterogeneously hypointense. In our study, the findings of CT and MRI of EBV + inflammatory FDCS in the liver and spleen are both similar and different. Eight out of ten patients showed heterogeneous density on CT, which may be related to hemorrhagic necrosis of the tumor. The varying degree of tumor necrosis in these cases may be related to the larger size of the tumor as larger masses are more prone to necrosis, seven out of eleven of our cases (diameter > 5 cm) had areas of necrosis with central hypodensity. EBV + inflammatory FDCS revealed weaker enhancement in the spleen than in the liver, which may be related to splenic parenchymal enhancement. All lesions showed inhomogeneous enhancement in the arterial phase, decreased enhancement in the PP of liver lesions, and progressive inhomogeneous enhancement in the PP and DP of splenic lesions. On MRI, like MRI enhancement imaging reported in the literature [13; 14] showing progressive enhancement of tumor parenchyma, in our study, two liver cases showed significant enhancement in AP and diminished enhancement in PP; the other liver case (2 lesions) showed no significant enhancement in AP and mild enhancement in PP and DP, suggesting that MRI enhancement pattern of hepatic FDCs was nonspecific, which may be related to the fact that there were fewer cases in our study. All three splenic lesions showed isointensity or hypointensity on T1WI and heterogeneous on T2WI. Enhancement showed inhomogeneous mild enhancement on AP and progressive enhancement on PP and DP, with irregular non-enhanced areas within one lesion and irregular peripheral enhancement in one case. This may be related to the large size of the mass with hemorrhagic necrosis. Therefore, the imaging manifestations of hepatic and splenic IPT-like FDCS have their own characteristics and need to be differentiated in diagnosis. The differential diagnosis of EBV + inflammatory FDCS of liver should include inflammatory pseudotumor, HCC, ICC, metastatic tumor, leiomyosarcoma, malignant fibrous histiocytoma, and in spleen should include sclerosing hemangiomatoid nodular transformation (SANT), hamartoma, hemangioma/angiosarcoma, malignant lymphoma. The imaging features of these tumors overlap with those of EBV + inflammatory FDCS, Thus the differential diagnosis is very difficult. Given the rarity of EBV + inflammatory FDCS. Preoperative imaging diagnosis of these tumors can be challenging. The correct final diagnosis depends on histopathological examination and immunohistochemical markers. Conclusions EBV + inflammatory FDCS is very rare, usually located in the spleen and liver, and has a lack of clinical specificity. We believe that complete CT and MRI examination may be of great help in the diagnosis of EBV + inflammatory FDCS. When single or multiple masses show different types of enhancement on CT and MRI, EBV + inflammatory FDCS should be considered in the differential diagnosis. However, the final diagnosis should be based on pathological morphology and immunohistochemical examination. Declarations Acknowledgements Not applicable. Authors’ contributions The research was conceived by JZ, XT and HY. XL, YZ and YL conducted a search and analysis of the data. XZ was the one who authored the first draft of the paper and KW drew the figures and tables. The manuscript was revised by JZ, XT and HY. The final document has been reviewed and approved by all of authors. Funding This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Availability of data and materials The data that supports the fndings of this study are available on request from the corresponding author upon reasonable request. Ethics approval and consent to participate The study was conducted in full compliance with ethical standards, with prior informed consent forms being duly obtained from all patients and their respective family members. Moreover, this research endeavor was approved by the Medical Ethics Committee of Hunan Provincial People Hospital (IRB Approval No.[2024]-72 ) Consent for publication Not applicable. Competing interests The authors declare no competing interests References Ge R, Liu C, Yin X, Chen J, Zhou X, Huang C, Yu W, Shen X. Clinicopathologic characteristics of inflammatory pseudotumor-like follicular dendritic cell sarcoma. Int J Clin Exp Pathol 7(5):2421–9. Cheuk W, Chan JK, Shek TW, Chang JH, Tsou MH, Yuen NW, Ng WF, Chan AC, Prat J. 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Imaging features of inflammatory pseudotumor-like follicular dendritic cell sarcoma of the spleen. Ann Palliat Med. 2021;10(12):12140–8. 10.21037/apm-21-2776 . Chen F, Li J, Xie P. Imaging and pathological comparison of inflammatory pseudotumor-like follicular dendritic cell sarcoma of the spleen: A case report and literature review. Front Surg. 2022;9:973106. 10.3389/fsurg.2022.973106 . Corvino A, Catalano O, Corvino F, Petrillo A. Rectal melanoma presenting as a solitary complex cystic liver lesion: role of contrast-specific low-MI real-time ultrasound imaging. J Ultrasound. 2016;19(2):135–9. 10.1007/s40477-015-0182-1 . Yan S, Yue Z, Zhang P, Yuan L, Wang H, Yin F, Ju L, Chen L, Cai W, Ni Y, Wu J. Case report: Hepatic inflammatory pseudotumor-like follicular dendritic cell sarcoma: a rare case and review of the literature. Front Med (Lausanne). 2023;10:1192998. 10.3389/fmed.2023.1192998 . Xu L, Ge R, Gao S. Imaging features and radiologic-pathologic correlations of inflammatory pseudotumor-like follicular dendritic cell sarcoma. BMC Med Imaging. 2021;21(1):52. 10.1186/s12880-021-00584-6 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4891123","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343032654,"identity":"1c2be731-6ac0-4945-9708-5ff4fbd4f77b","order_by":0,"name":"Jie Zhao","email":"","orcid":"","institution":"Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University)","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Zhao","suffix":""},{"id":343032655,"identity":"dbdd8946-ed87-4f93-b512-621a639db677","order_by":1,"name":"Kun Wang","email":"","orcid":"","institution":"Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University)","correspondingAuthor":false,"prefix":"","firstName":"Kun","middleName":"","lastName":"Wang","suffix":""},{"id":343032656,"identity":"84a58b4b-1ca1-4d5a-9580-72e2bef96e99","order_by":2,"name":"Xiaoying Liu","email":"","orcid":"","institution":"Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University)","correspondingAuthor":false,"prefix":"","firstName":"Xiaoying","middleName":"","lastName":"Liu","suffix":""},{"id":343032657,"identity":"90324c58-802f-458e-a2b9-22d6e0369ed7","order_by":3,"name":"Xuemei Zeng","email":"","orcid":"","institution":"Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University)","correspondingAuthor":false,"prefix":"","firstName":"Xuemei","middleName":"","lastName":"Zeng","suffix":""},{"id":343032658,"identity":"0baacc4f-f4dd-41e4-bc2f-a62b538d1c83","order_by":4,"name":"Yanchun Li","email":"","orcid":"","institution":"Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University)","correspondingAuthor":false,"prefix":"","firstName":"Yanchun","middleName":"","lastName":"Li","suffix":""},{"id":343032659,"identity":"284b490b-740e-437e-8de3-f557ade70c17","order_by":5,"name":"Yuli Zeng","email":"","orcid":"","institution":"Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University)","correspondingAuthor":false,"prefix":"","firstName":"Yuli","middleName":"","lastName":"Zeng","suffix":""},{"id":343032660,"identity":"c2c78308-51d9-42c8-bbf7-25d8e875d1b9","order_by":6,"name":"Xianzheng Tan","email":"","orcid":"","institution":"Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University)","correspondingAuthor":false,"prefix":"","firstName":"Xianzheng","middleName":"","lastName":"Tan","suffix":""},{"id":343032661,"identity":"a40c1e9d-633a-4ca4-85ba-c9e6f4c52094","order_by":7,"name":"Hong Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACAxiDXwLGOkCsFskZJGsxuEGsFnP23sOveWru2G2+3WP2uLCNQY7vRgLj5wI8Wix7zqVZ8xx7lrztzhlz45ltDMaSNxKYpWfg0WJwI8fMmIftcLIZkCHN28aQuOFGAhszD0Et/w4nG8+AaKknRovxY962w3YGEhAtCQYEtZw5Y8Y4t+9wgsSNtDJpnnMShjPPPGyWxqvleI/xhzffDtvzz0jeJs1TZiPPdzz54Gd8WoCATQqoILEBwgGlAcYG/BoYGJg//mBgsCekahSMglEwCkYwAADkY0uIJnfkJwAAAABJRU5ErkJggg==","orcid":"","institution":"Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University)","correspondingAuthor":true,"prefix":"","firstName":"Hong","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2024-08-10 09:48:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4891123/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4891123/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66083421,"identity":"f85cd3d2-1ad3-4e05-a02d-5b79bfc5b437","added_by":"auto","created_at":"2024-10-07 14:12:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":147849,"visible":true,"origin":"","legend":"\u003cp\u003eA 60-year-old woman with hepatic EBV+ inflammatory FDCS.\u003c/p\u003e\n\u003cp\u003eA-B: Ultrasound images, revealing a heterogeneous hypoechoic and peripheral hypoechoic halo lesion with punctate blood flow signals within the mass located in segment 7 of the liver.\u003c/p\u003e\n\u003cp\u003eC-E: The unenhanced and enhanced CT images. C: Plain CT showing an oval hypodense lesion with well-defined in the segment 7 of the liver. D: Heterogeneous enhancement in arterial phase. E: Decreased enhancement in portal phase.\u003c/p\u003e\n\u003cp\u003eF-M: The MRI non-enhanced and enhanced images. F: The mass showing a low signal on T1WI. G: The mass showing a high signal on T2WI. H–J: The enhanced scan showing uneven enhancement in the arterial phase and decreased enhancement in the portal and delayed phases.\u003c/p\u003e\n\u003cp\u003eK: The mass showing a high signal on DWI. L: The ADC value of lesion decreased. M: Low uptake changes in hepatobiliary specific phase.\u003c/p\u003e\n\u003cp\u003eN: On histopathological examination, the tumor cells were surrounded by dense fibrous tissue (hematoxylin and eosin, ×100). O: CD35 was positive. P: Epstein–Barrvirus was detected in the tumor cells with positive dark staining of their nuclei.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4891123/v1/0abf9e524b1a7b422a735f9c.jpg"},{"id":66083422,"identity":"4e0467a3-49ad-4543-bba6-7f56cb1892f9","added_by":"auto","created_at":"2024-10-07 14:12:17","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":156952,"visible":true,"origin":"","legend":"\u003cp\u003eA 66-year-old male with EBV+ inflammatory FDCS of the spleen.\u003c/p\u003e\n\u003cp\u003eA-B: Ultrasound image, revealing a heterogeneous hypoecho lesion with internal and peripheral punctate or striated blood flow located in the spleen\u003c/p\u003e\n\u003cp\u003eC-F: The CT non-enhanced and enhanced images. C: Plain CT showing an oval, hypodense lesion in the spleen with punctate calcifcations. D: Slight enhancement in AP. E and F: Progressive enhancement in PP and DP.\u003c/p\u003e\n\u003cp\u003eG-L: The MRI non-enhanced and enhanced images. G: The mass showing an iso-or low signal on T1WI. H: The mass showing a mixed signal on T2W with multiple lobulated changes at the edge. I–K: The enhanced scan showing mild heterogeneous enhancement in the arterial phase and continued enhancement in the portal and delayed phases.\u003c/p\u003e\n\u003cp\u003eL: Macroscopic examination showing a gray-white-gray-red tumor with clear boundaries. M: On histopathological examination, the tumor cells were surrounded by dense fibrous tissue (hematoxylin and eosin, ×100). N: CD35 was positive. O: Epstein–Barrvirus was detected in the tumor cells with positive dark staining of their nuclei.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4891123/v1/aa27b3915f322092ea8aaa96.jpg"},{"id":67154512,"identity":"b0c41b04-2c14-4b4c-9708-9c675dc632ef","added_by":"auto","created_at":"2024-10-21 17:32:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1089757,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4891123/v1/246fa6c6-2a47-46cd-a3b3-7dba0450fee2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinicopathological and Imaging Characteristics of EBV Positive Inflammatory Follicular Dendritic Cell Sarcoma","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInfammatory pseudotumor-like follicular dendritic cell sarcomais a rare, Epstein-Barr virus (EBV)\u0026ndash;associated neoplasm, characterized by spindly tumor cells dispersed in a background of small lymphocytes and plasma cells. In 2022, the World Health Organization has named infammatory pseudotumor-like follicular dendritic cell sarcomais as EBV positive inflammatory follicular dendritic cell sarcoma (EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS). EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS is inert in biological behavior, and surgical resection can achieve good long-term efficacy\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Therefore, accurate diagnosis before surgery is very important. To our knowledge, EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS has mainly been reported in case studies analyzing clinicopathological features with only a little previous literatures incorporating imaging findings. The purpose of this study is to improve the diagnosis of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS and provide a basis for clinical diagnosis by analyzing the radiological and clinicopathological features of twelve cases with EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS from Hunan Provincial People\u0026rsquo;s Hospital /The First Affiliated Hospital of Hunan Normal University.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eTwelve patients with EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS confirmed by surgical pathology were enrolled from January 2018 and June 2023. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the patients included three males and nine females, with an average age of 53-year-old (rang, 31\u0026ndash;71years). Six patients (50.0%) presented with abdominal distention or abdominal pain or fever, and six patients (50.0%) were incidentally found during health checkups. Serum tumor marker examinations including α-fetoprotein \u003cb\u003e(AFP)\u003c/b\u003e, carcinoembryonic antigen \u003cb\u003e(CEA)\u003c/b\u003e, carbohydrate antigen 199 \u003cb\u003e(CA199)\u003c/b\u003e, and carbohydrate antigen 125 \u003cb\u003e(CA125)\u003c/b\u003e revealed that twelve patients had no significant abnormalities. Hepatitis B virus surface antigen was negative in twelve patients. Preoperative images and postoperative pathological data of all patients were reviewed. Follow-up data were obtained by telephone. Informed consent was obtained from patients upon research authorization by the Medical Ethics Committee of Hunan Provincial People Hospital (IRB Approval No.[2024]-72).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS patients (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003cp\u003eno\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExamination method\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInitial Diagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eoutcome\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT and MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSANT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMRI, ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePain in the\u003c/p\u003e \u003cp\u003eright upper abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT, ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSpleen space -occupying lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLiver (right lobe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntermittent fever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMRI, ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLiver (right lobe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT, ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRecurrence, survival with tumor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDysplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT and MRI ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSpleen space -occupying lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePain in the\u003c/p\u003e \u003cp\u003eleft upper abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT and MRI ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSANT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLiver (S6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePain in the\u003c/p\u003e \u003cp\u003eright upper abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT, ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLiver (S8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePain in the\u003c/p\u003e \u003cp\u003eright upper abdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT, ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLiver space -occupying lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSANT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLiver (S7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePain in the\u003c/p\u003e \u003cp\u003eabdomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCT and MRI ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eICC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSurgical excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTumor-free survival\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote\u0026mdash;F\u0026thinsp;=\u0026thinsp;female, M\u0026thinsp;=\u0026thinsp;male, HCC\u0026thinsp;=\u0026thinsp;hepatocellular carcinoma, ICC\u0026thinsp;=\u0026thinsp;intrahepatic cholangiocarcinoma, SANT\u0026thinsp;=\u0026thinsp;sclerosing angiomatoid nodular transformation of the soleen.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eImage Acquisition\u003c/h2\u003e \u003cp\u003ePatients underwent the abdominal CT or MRI examinations. CT was performed in ten patients, MRI in six patients, both CT and MRI in four patients.\u003c/p\u003e \u003cp\u003eThe CT examinations were performed using the following two systems: Philips Brilliance iCT (Netherlands) (n\u0026thinsp;=\u0026thinsp;4) or Neusoft NeuViz 64i CT (Shenyang, China) (n\u0026thinsp;=\u0026thinsp;6). The acquisition parameters were as follows: tube voltage of 120 kVp, tube current of165\u0026ndash;375 mA determined by automatic tube current adjustment, slice thickness of 5 mm, and pitch of 0.984:1. Contrast-enhanced CT was performed after a bolus intravenous injection of 1.5 mL/kg of a nonionic contrast agent (350mgI/mL, 100mL, Shanghai General Electric Pharmaceutical Co., Ltd, Shanghai, China) through the anterior cubital vein by dual cylinder high-pressure injector (Ulrich, Germany) at a rate of 3.0\u0026ndash;4.0mL/s. After injection of contrast agent, the arterial phase (AP)and portal vein phase (PP) and delayed phase (DP)scanning were performed at a delay of 25\u0026ndash;30s, 60\u0026ndash;65s and 120s, respectively.\u003c/p\u003e \u003cp\u003eMRI was performed using a Siemens Magnetom Trio A Tim System 3.0t MR scanner (Germany) with a torso coil. The routine MRI protocol was performed and consists of the following MRI sequences: a T2-weighted imaging (T2WI) fast spin-echo or turbo spin-echo sequence, a fat-suppressed respiratory-triggered heavily T2WI sequence, and a T1-weighted imaging (T1WI) gradient-recalled echo sequence with and without chemically selective fat suppression. diffusion-weighted imaging(DWI)was performed using a respiratory-triggered single-shot echo-planar sequence with b values of 0 and 800 s/mm2. Contrast-enhanced MRI was performed with dimeglumine gadopentetate (12mL, Guangzhou Kangchen Pharmaceutical Co., Ltd, Guangzhou, China) was intravenously injected through the anterior cubital vein by dual cylinder high-pressure injector, the dose of contrast agent was about 20\u0026ndash;24mL(0.4mL/kg), and the flow rate was 2.0\u0026thinsp;~\u0026thinsp;3.0mL/s. Contrast enhanced images were obtained with a scanning delay of 20\u0026thinsp;~\u0026thinsp;25s (AP) and 60\u0026ndash;65s (PP) and 120s (DP) after the start of contrast agent injection.\u003c/p\u003e \u003cp\u003eNine of the twelve patients underwent ultrasound imaging using the Philips S2000 or Toshiba Aplio500 (Toshiba, Tokyo, Japan) system, and one of them underwent contrast-enhanced ultrasound. The frequency of the convex array probe is 3.5-5.0 MHz.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eImage Analysis\u003c/h2\u003e \u003cp\u003eTwo associate professors read the images independently, and the resulting quantitative data were averaged. If the qualitative data were inconsistent, the two radiologists read the images again and reached a verbal consensus. Main parameters include lesion site (accurate to segment), number (single or multiple), size (maximum diameter(cm), accurate to one decimal point), shape (round, oval, irregular or lobulated), margin (clear or unclear, capsule or not), density/signal (homogeneous or heterogeneous, calcification, hemorrhage, cystic/necrosis), enhanced images (enhanced mode, degree), adjacent tissues and metastasis (invasion of adjacent viscera, vascular embolus, lymph node, metastasis).\u003c/p\u003e \u003cp\u003eUltrasonography analysis: Two associate professors read the images independently and the resulting quantitative data were averaged. If the qualitative data did not agree, the two sonographers would read the images again and reach a verbal consensus. The main parameters included: lesion site, number, size, shape, margins, internal echoes, color doppler flow, enhancement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePathologic Evaluation\u003c/h2\u003e \u003cp\u003eIn all twelve cases, the tumors were resected, and the tissue samples were examined using hematoxylin and eosin (HE) staining as well as immunohistochemical EnVision staining. The antibodies that were used are listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Two pathologists with 18 years of experience analyzed the histopathologic specimens after surgery. Appropriate positive and negative controls were evaluated simultaneously. In situ hybridization for Epstein\u0026ndash;Barr virus (EBV)-encoded RNA (EBER) was performed in the twelve cases using an EBV probe in situ hybridization kit (Novocastra, Newcastle upon Tyne, United Kingdom). The manufacturer\u0026rsquo;s instructions were followed with no modification, and a known positive control was used to ascertain the sensitivity of the assay.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAntibodies used for immunostaining\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibodies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClonality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDilution\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003epretreatment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS-100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDesmin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSMA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCK-P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaixin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMonoclonal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eready-to-use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eHT\u003c/em\u003e High-temperature repair 20min in Titan Instrument DNS Repair solution\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Method\u003c/h2\u003e \u003cp\u003eAll patients underwent surgical excision. Two liver case hepatic segments (S6) resection; hepatic segments (S7) performed in one liver case; hepatic segments (S8) performed in one liver case; hepatic right lobectomy resection in two liver case, and the lymph node dissection was performed in one case. All six spleen cases underwent splenectomy. No tumor tissue was found at the cutting edge of any of the pathologic specimens.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eUltrasonography Findings\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Six patients with hepatic lesions and four patients with splenic lesions underwent ultrasonography examination. One patient had two hepatic lesions and the remaining nine patients had single lesions. Ten lesions were regular or lobulated with well-defined borders (maximal diameters range: 1.4 to 10.6 cm), and only one hepatic lesion was irregular shape with ill-defined border (maximum diameter:10.9 cm). Eight lesions showed uneven internal echoes with peripheral hypoechoic or hyperechoic halo in three hepatic lesions and even internal echoes in three lesions. Color Doppler flow imaging showed punctate or striated flow signals within eight lesions, in which peripheral circumferential flow signals were seen in three hepatic lesions and two splenic lesions. Only one patient with hepatic lesion underwent contrast-enhanced ultrasonography, which showed rapid hyperenhancement in AP and hypoenhancement in PP and DP.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreoperative US Findings of Eleven Patients with EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSite\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaximum Diameter\u003c/p\u003e \u003cp\u003e(cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eShape\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMargins\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003einternal echo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCDFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEnhancement\u003c/p\u003e \u003cp\u003ePattern\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eeven internal echoes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRapid high enhancement AP, low enhancement in PP and DP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver (right lobe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8 and\u003c/p\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elow uneven internal echoes and peripheral ring hyperechoic bands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eflow signals around the tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver (right lobe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eirregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eunclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003euneven internal echoes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003erich flow signals within the tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eslightly high even internal echoes, and peripheral hypoechoic halo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003epunctate flow signals within and around the tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eeven internal echoes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elow uneven internal echoes, and peripheral hypoechoic halo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003epunctate flow signals within tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elow uneven internal echoes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003epunctate flow signals within the tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elow uneven internal echoes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003elobulated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elow uneven internal echoes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003epunctate or striated flow signals within and around the tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003elow uneven internal echoes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eflow signals within and around the tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote\u0026mdash; NA\u0026thinsp;=\u0026thinsp;not available. CDFI\u0026thinsp;=\u0026thinsp;color doppler flow.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCT Findings\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the imaging characteristics of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS differed slightly between the liver and spleen. Four liver cases and six spleen cases underwent CT examination. Nine cases showed heterogeneous hypodensities with rounded or lobulated borders on unenhanced CT, with multiple punctate foci of calcification within one splenic lesion. Only one hepatic lesion had an irregular shape with ill-defined accompanied by multiple lymph node metastases in the portahepatric area, and the diameter of largest lymph node was approximately 3.5 cm. On enhancement scanning, all four hepatic lesions showed significant enhancement in AP, decreased enhancement in PP and DP. In these four hepatic lesions, one hepatic lesion showed \"fast in -fast washout\" with nonenhancement necrosis area in the lesion; and one hepatic lesion showed striated foci of relative hypoenhancement in the center of the lesion in AP, and the extent of relative hypoenhancement in the center was smaller than before in PP and DP. All six splenic lesions showed mild to moderate enhancement in AP and continued enhancement in PP and DP. Among the 6 splenic lesions, four lesions showed patches of necrosis without enhancement, and one lesion showed irregular peripheral enhancement. Two liver cases were misdiagnosed as HCC, one liver case was misdiagnosed as ICC; three spleen cases were misdiagnosed as sclerosing angiomatous nodular transformations (SANT), and one spleen case was misdiagnosed as a misshapen tumor or hemangioma.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreoperative CT Findings of Eleven Patients with EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003esite\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaximum Diameter (cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eShape\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo-contrast\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eArterial phase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePortal phase and delayed phase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDynamic\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003cp\u003epattern\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver (right lobe)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHuge ill-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003emarked heterogeneous enhancement with necrosis without enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEnhancement attenuation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003efast in -fast washout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003emarked enhancement with relatively low enhancement focus in the center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEnhancement attenuation and relative smaller low enhancement extent in the center than before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003efast in -fast washout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003emarked enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEnhancement attenuation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003efast in -fast washout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eheterogeneous enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEnhancement attenuation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHeterogeneous mild\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emarked heterogeneous enhancement with patchy necrosis without enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePatchy marked enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProgressive enhancement with some non-enhancement\u003c/p\u003e \u003cp\u003ehypointense foci\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUneven hypoenhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProgressive enhancement with patchy non-enhancement\u003c/p\u003e \u003cp\u003efoci\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIrregular peripheral enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIrregular peripheral enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous\u003c/p\u003e \u003cp\u003ehypodensity with multiple punctate calcifications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMild enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProgressive mild enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eheterogeneous iso-low density\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMild enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProgressive mild enhancement with some non-enhancement\u003c/p\u003e \u003cp\u003ehypointense foci\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote\u0026mdash;O\u0026thinsp;=\u0026thinsp;oval, L\u0026thinsp;=\u0026thinsp;lobulated, I\u0026thinsp;=\u0026thinsp;irregular. a\u0026thinsp;=\u0026thinsp;Cases 4, 5, 8 and 9 had both CT and MRI scans.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMRI Findings\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, three liver cases underwent MRI examination, which revealed four well-defined quasi-circular lesions, one case had two lesions (maximum diameters: 2.1 cm and 3.8 cm, respectively) and the other two cases had one lesion each (maximum diameter: 1.8 cm and 3.8 cm, respectively). All four liver lesions showed mild low signals on T1WI and mild high signals on T2WI, and exhibited high signal on DWI. The two liver cases were markedly enhanced in AP, with clearing changes observed in the venous phase and low uptake changes observed in the hepatobiliary-specific phase \u003cb\u003e(HSP)\u003c/b\u003e. The other two liver lesions showed mild enhancement with low uptake changes in the HSP. The three spleen cases underwent MRI examination, and all had single lesions (maximum diameters: 7.2 cm, 10.5 cm, and 10.6 cm, respectively) with well-defined. All three splenic lesions showed iso-or low signals on T1WI and mixed signals on T2WI. The splenic lesions showed heterogeneous mild enhancement in AP and progressive enhancement in PP and DP with irregular non-enhancing areas within one lesion and irregular peripheral enhancement in one case.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreoperative MRI Findings of Eleven Patients with EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003esite\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaximum Diameter (cm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eShape\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo-contrast\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eArterial phase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePortal phase and delayed phase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHepatobiliary\u003c/p\u003e \u003cp\u003ephas\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eDynamic\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003cp\u003epattern\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined,\u003c/p\u003e \u003cp\u003eslightly longer T1 signal and slightly longer T2 signal, DWI high signal, corresponding ADC value reduced.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003emarked heterogeneous enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eClearance changes occurred in venous phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLow uptake rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003efast in -fast washout\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8 and 2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined,\u003c/p\u003e \u003cp\u003elong T1 and slightly longer T2,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo obvious enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMild enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLow uptake rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver\u003c/p\u003e \u003cp\u003e(S7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined,\u003c/p\u003e \u003cp\u003elong T1 signal and long T2 signal, DWI high signal, corresponding ADC value reduced.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eheterogeneous enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEnhancement attenuation,Clearance changes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLow uptake rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined,\u003c/p\u003e \u003cp\u003eslightly longer T1 and slightly longer T2, (mixed central signals)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eheterogeneous mild enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProgressive enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIrregular peripheral enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProgressive irregular peripheral enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpleen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWell-defined\u003c/p\u003e \u003cp\u003eT1WI slightly longer signal and T2 mixed signal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eheterogeneous mild enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProgressive enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHeterogeneous\u003c/p\u003e \u003cp\u003esustained\u003c/p\u003e \u003cp\u003eenhancement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eNote\u0026mdash;O\u0026thinsp;=\u0026thinsp;oval, L\u0026thinsp;=\u0026thinsp;lobulated. a\u0026thinsp;=\u0026thinsp;Cases3, 4, 5 and 6 had both CT and MRI scans.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePathology results\u003c/h2\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the pathologic features of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS in the liver and spleen were very similar. Macroscopically, the masses were round or oval, solid, grayish-white or grayish-red on section, with well-defined borders, and visible fibrous pseudocapsules extruding into the surrounding tissues. necrosis was present in four cases of larger lesions, and hemorrhage was present in one case. Histological examination showed that the tumor cells were dispersed or arranged in bundles among prominent lymphocytes and plasma cells, with granulomatous changes in two of the splenic cases. Tumor cells were spindle-shaped with indistinct borders and abundant reddish cytoplasm. The nuclei were elongated and vesicular, and the nucleoli were small and obvious. Nuclear division was rare, and multinucleated giant cells were seen in some cases. Immunophenotypically, CD21, CD23 and CD35 were expressed in varying degrees in all twelve cases. By in situ hybridization analysis, all cases were positive for EBER.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS was first reported in 2001 by CHEUK et al\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Its histopathology is different from classical FDCS and is closely related to EBV infection. Compared with classical FDCS, EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS is more frequently observed in adult female patients, and our study is similar to previous findings[1].The majority of patients were clinically asymptomatic or asymptomatic, in our study population, there were no significant typical symptoms other than those of abdominal discomfort and fever, in addition, the levels of serum tumour markers AFP, CEA, CA199 and CA125 observed in our study were within the normal range, which is consistent with previously reported results\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS is an inert sarcoma, and surgical resection is the first choice of treatment. For patients with tumor recurrence or those who cannot be treated by surgery, chemotherapy or radiotherapy can be administere\u003csup\u003e[\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Among the twelve patients, only one liver patient with hilar lymph node metastasis recurred more than two years after the first surgical resection, underwent a second surgery and four courses of chemotherapy, and now coexists with the tumor. This suggests that although EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS is low-grade malignant, local lymph node metastasis and recurrence are still possible.\u003c/p\u003e \u003cp\u003eThe diagnosis of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS is based on variable numbers of tumor cells in a background of severe inflammation, coupled with supportive immunohistochemistry and is associated with the Epstein\u0026ndash;Barr virus, and the best available immunohistochemical markers for EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS are CD21, CD23 and CD35\u003csup\u003e[2; 8]\u003c/sup\u003e. All patients in our cohort were positive for at least one FDC marker (CD21, CD35, CD23) and the Epstein\u0026ndash;Barr encoding region, so the diagnosis of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS was clear.\u003c/p\u003e \u003cp\u003eTo date, the imaging findings of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS are rarely reported, with most imaging reports coming from individual cases or small cohorts\u003csup\u003e[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. In our study, we found that EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS had nonspecific findings on unenhanced ultrasonography, making it difficult to distinguish from other tumours\u003csup\u003e[12; 13]\u003c/sup\u003e. Only one liver patient underwent CEUS in this study, which showed rapid hyper-enhancement in the arterial phase and hypo-enhancement in the portal and delayed phases, which was consistent with MRI finding. On CT and MRI, intrahepatic and splenic tumours are usually homogeneously or heterogeneously hypointense. In our study, the findings of CT and MRI of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS in the liver and spleen are both similar and different. Eight out of ten patients showed heterogeneous density on CT, which may be related to hemorrhagic necrosis of the tumor. The varying degree of tumor necrosis in these cases may be related to the larger size of the tumor as larger masses are more prone to necrosis, seven out of eleven of our cases (diameter\u0026thinsp;\u0026gt;\u0026thinsp;5 cm) had areas of necrosis with central hypodensity. EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS revealed weaker enhancement in the spleen than in the liver, which may be related to splenic parenchymal enhancement. All lesions showed inhomogeneous enhancement in the arterial phase, decreased enhancement in the PP of liver lesions, and progressive inhomogeneous enhancement in the PP and DP of splenic lesions. On MRI, like MRI enhancement imaging reported in the literature\u003csup\u003e[13; 14]\u003c/sup\u003eshowing progressive enhancement of tumor parenchyma, in our study, two liver cases showed significant enhancement in AP and diminished enhancement in PP; the other liver case (2 lesions) showed no significant enhancement in AP and mild enhancement in PP and DP, suggesting that MRI enhancement pattern of hepatic FDCs was nonspecific, which may be related to the fact that there were fewer cases in our study. All three splenic lesions showed isointensity or hypointensity on T1WI and heterogeneous on T2WI. Enhancement showed inhomogeneous mild enhancement on AP and progressive enhancement on PP and DP, with irregular non-enhanced areas within one lesion and irregular peripheral enhancement in one case. This may be related to the large size of the mass with hemorrhagic necrosis. Therefore, the imaging manifestations of hepatic and splenic IPT-like FDCS have their own characteristics and need to be differentiated in diagnosis.\u003c/p\u003e \u003cp\u003eThe differential diagnosis of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS of liver should include inflammatory pseudotumor, HCC, ICC, metastatic tumor, leiomyosarcoma, malignant fibrous histiocytoma, and in spleen should include sclerosing hemangiomatoid nodular transformation (SANT), hamartoma, hemangioma/angiosarcoma, malignant lymphoma. The imaging features of these tumors overlap with those of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS, Thus the differential diagnosis is very difficult. Given the rarity of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS. Preoperative imaging diagnosis of these tumors can be challenging. The correct final diagnosis depends on histopathological examination and immunohistochemical markers.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eEBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS is very rare, usually located in the spleen and liver, and has a lack of clinical specificity. We believe that complete CT and MRI examination may be of great help in the diagnosis of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS. When single or multiple masses show different types of enhancement on CT and MRI, EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS should be considered in the differential diagnosis. However, the final diagnosis should be based on pathological morphology and immunohistochemical examination.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conceived by JZ, XT and HY. XL, YZ and YL conducted a search and analysis of the data. XZ was the one who authored the first draft of the paper and KW drew the figures and tables. The manuscript was revised by JZ, XT and HY. The final document has been reviewed and approved by all of authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that supports the fndings of this study are available on request from\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ethe corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in full compliance with ethical standards, with prior informed consent forms being duly obtained from all patients and their \u0026nbsp;respective family members. Moreover, this research endeavor was approved by the Medical Ethics Committee of Hunan Provincial People Hospital (IRB Approval No.[2024]-72 ) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGe R, Liu C, Yin X, Chen J, Zhou X, Huang C, Yu W, Shen X. Clinicopathologic characteristics of inflammatory pseudotumor-like follicular dendritic cell sarcoma. Int J Clin Exp Pathol 7(5):2421\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheuk W, Chan JK, Shek TW, Chang JH, Tsou MH, Yuen NW, Ng WF, Chan AC, Prat J. 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BMC Med Imaging. 2021;21(1):52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12880-021-00584-6\u003c/span\u003e\u003cspan address=\"10.1186/s12880-021-00584-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"EBV positive inflammatory follicular dendritic cell sarcoma, computed tomography, magnetic resonance imaging, ultrasonography","lastPublishedDoi":"10.21203/rs.3.rs-4891123/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4891123/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eEBV-positive inflammatory follicular dendritic cell sarcoma (EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS) is a rare tumor that has been less systematically studied. This study aims to improve the understanding of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS by analyzing radiological imaging data and clinicopathological features.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was performed on twelve patients with EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS confirmed pathologically. Ten patients underwent computed tomography (CT) scans, six underwent magnetic resonance imaging (MRI) scans, and four patients underwent CT and MRI scans simultaneously.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwelve patients (six in the liver and six in the spleen) had clinically asymptomatic or asymptomatic, and six cases were found on physical examination. Pathologically, the tumor cells dispersed in a background of inflammatory cells. All cases showed positive expression of at least one follicular dendritic cell (FDC) marker and EBV. On unenhanced CT images, nine cases of EBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS presented as well-defined iso-or hypodense masses, and one liver case had an irregularly shaped lesion with unclear borders. All cases showed iso-or hypodensity signals on T1WI and mixed signals on T2WI. The hepatic lesions showed marked enhancement in arterial phase and diminished enhancement in portal vein phase and delayed phase, whereas the splenic lesions showed mild enhancement in arterial phase and continued enhancement in portal vein phase and delayed phase .\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEBV\u0026thinsp;+\u0026thinsp;inflammatory FDCS is a rarely low-grade malignant tumor, which exists the possibility of local lymph node metastasis and recurrence. Therefore, the preoperative diagnosis is expected to improve by carefully analyzing the imaging features and clinical characteristics of the patients.\u003c/p\u003e","manuscriptTitle":"Clinicopathological and Imaging Characteristics of EBV Positive Inflammatory Follicular Dendritic Cell Sarcoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-07 14:12:13","doi":"10.21203/rs.3.rs-4891123/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d7b97ffb-f8d3-4a3c-9120-f0d8a27653ed","owner":[],"postedDate":"October 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T17:23:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-07 14:12:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4891123","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4891123","identity":"rs-4891123","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}