A 70-year-old male patient with type 2 diabetes mellitus of five years of evolution, who began suffering from this disease six months prior to hospitalization with intermittent episodes of respiratory infection.
Laboratory studies showed: leukocytes 38.3 thousands/mm3, hemoglobin 14.7 g/dl and platelets 153 thousands/mm3, reason why he was referred to the National Cancer Institute for evaluation and management.
Upon admission, she was in good general condition and physical examination revealed left cervical adenomegaly of 2 cm, of major axis.
A new blood biometry was performed, reporting leukocytes 48.8 thousands/mm3 with 98% of lymphocytes, hemoglobin 14.9 g/dl and platelets 264 thousands/mm3.
Bone biopsy showed hypercellular bone marrow with substitution of hematopoiesis by small lymphocytes of regular contours, finely granular chromatin, little apparent nucleolus CD-25, which established CD22 and Lcl cells.
Bone marrow aspirate reported chronic lymphocytic leukemia (CLL) with the following immunophenotype: HLA-DR 85%, CD5 84%, CD20 74%, CD22 77% and CD79a 65%.
A computed axial tomography was performed, reporting infra- and supradiaphragmatic lymphadenopathy.
Subsequently, a cervical lymph node biopsy was performed which measured 2.0 x 1.5 x 1.2 cm. In the histopathological study it was observed loss of its architecture in focal hyoid stroma, consisting of fusiform cells and arranged epithelia.
Some of these cells had cytoplasmic vacuums with occasional erythrocytes.
Cytological atypia was moderate with few mitotic figures.
Immunohistochemical reactions were performed using antibodies against vimentin (V9; 1:150 BioGenex), CD31 (1A10; 1:50 BioSB), CD34 (QBEnd/10 actin 1:75 BiocareMA);
Signaling cells expressed vimentin, CD34 and CD31, which confirmed the diagnosis of HEF of the lymph node.
Currently, the patient is alive, there is no documented blade tissue injury and receives treatment with chlorambucil and prednisone for CLL.
