We observed a neoformation on the lateral aspect of the orbital cavity, resulting in compression of the ocular globe. This neoformation has almost well-defined margins, heterogeneous echogenicity with a positive Color Doppler signal.*

During the clinical examination, at the left flank level, we reported the presence of two subcutaneous lesions, mobile and compact in consistency, which have well-defined margins and heterogeneous echogenicity; positive Color Doppler signal.*

FNA → Cytological exam: "Malignant round cell neoplasm, first hypothesis high-grade lymphoma".

Following the outcome of the cytological examination of the skin and eye lesions, we requested an abdominal ultrasound examination in order to complete the diagnostic procedure for patient staging.

At the gastrointestinal level, multifocal wall thickening with eccentric growth is evident, with partial loss of the stratigraphy, mainly hypoechoic in the absence of mechanical obstruction phenomena.*

We can appreciate:

• Generalized abdominal lymphadenopathy, loss of fat hilus, impaired short/long axis ratio, heterogeneous and hypoechoic parenchyma. *
• Heterogeneous and hypoechoic splenic parenchyma with rare round, well-defined and hyperechoic lesions. **

There is mild diffuse peritoneal scattering with little accumulation of anechoic effusion and an infiltrative lesion of the transverse abdominal fascia near the linea alba, iso-hypoechoic to the intestinal muscle.*

We further studied the lymph node vascularization, apparently negative to the Color Doppler signal, using the microV, thanks to which a low flow vascularization was highlighted, with the presence of pericapsular/subcapsular vessels.

FNA of the abdominal visceral lesions is performed with the following outcome: “Cytological picture compatible with malignant round cell neoplasm, in the first hypothesis high-grade lymphoma”.

Images were acquired with the MyLab^™X8VET ultrasound system.
The speed of some clips could have been modified to improve the visualization of the clinical outcome.