case_images: PMC8656165_01
case_images: Maximum-intensity-projection images of 18F-FDG PET/CT at baseline (8 Sept) and 22 days later (30 Sept), 8 days after BNT162b2 mRNA vaccine injection in right deltoid. 8 Sept: hypermetabolic lymph nodes mainly in the supra-clavicular, cervical, and left axillary regions; restricted gastro-intestinal hypermetabolic lesions. 30 Sept: Dramatic increase in nodal and gastro-intestinal hypermetabolic lesions. Asymmetrical metabolic progression in the cervical, supra-clavicular and axillary area, more pronounced on the right side.
case_images: fmed-08-798095-g0001.jpg
case_images: PMC8656165_01_fmed-08-798095-g0001.jpg
case_images: F1
case_images: A 18F-FDG PET/CT revealed multiple voluminous hypermetabolic lymphadenopathies above and below the diaphragm as well as several extra-nodal hypermetabolic lesions (Figure 1, left panel). Furthermore, new hypermetabolic lymphadenopathies and new hypermetabolic sites had developed since the first examination, in several different locations (Figure 1, right panel).
case_images: Biopsy specimen. (A,B) H&E stainings showing architectural disturbance due to a medium-sized lymphoid population with a clear cell morphology. (C-F) Immunohistochemical stainings establishing the TFH origin of the abnormal cell population: CD3+, CD4+, CD10+ (not shown), ICOS+ (C), PD1 (D), BCL6 (E) and expression of CD30 (F). CD21 staining (G) shows an extended network of follicular dendritic cells. (H) Intermediate sized EBV+ immunoblasts by EBER in situ hybridization. Scalebar: 100 mum.
case_images: fmed-08-798095-g0002.jpg
case_images: PMC8656165_01_fmed-08-798095-g0002.jpg
case_images: F2
case_images: TFH cell markers (CD3, CD4, PD1, ICOS, BCL6, CXCL13) and a loss of CD7. The paracortical area contained an increased number of high-endothelial venules, supported by an increased number of follicular dendritic cell networks, with some foci of EBV+ B-cell immunoblastic proliferation in the background (Figure 2). These features highly suggested a diagnosis of AngioImmunoblastic T cell Lymphoma (AITL), pattern 2.