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case_images: Computed tomography (CT) revealed left cervical lymphadenopathy (a) and hepatosplenomegaly (b).
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case_images: Computed tomography (CT) revealed left cervical lymphadenopathy and hepatosplenomegaly (Fig. 1a, b).
case_images: Diffuse proliferation of atypical small lymphocytes in the involved lymph node (a). The lymphoid cells were positive for CD3 (b) and CD5 (c); partially positive for ICOS (d), TIA1 (e), and granzyme B (f); and negative for CD10 (g), CD56 (h), CD30 (i), and EBER (j) based on in situ hybridization.
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case_images: Only a few scattered EBV-encoded small RNA (EBER)-positive cells were detected in the lymph nodes, but they were unlikely to be the main lesions (Fig. 2a-j).
case_images: CT showed ascitic fluid on day 14 (a), and peritoneum thickening (b) and hepatosplenomegaly (c) on day 25.
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case_images: On day 14, CT revealed an increase in ascitic fluid without abscess, necrosis of the pancreas, or intestinal perforation (Fig. 3a). Hepatosplenomegaly, however, was unchanged compared to that at the first examination (Fig. 3b, c).
case_images: May-Giemsa staining of ascitic fluid aspiration revealed that the majority of nucleated cells were the small to medium sized atypical lymphoid cells (a). The atypical lymphoid cells were positive for CD3 (b), CD56 (c), TIA1 (d), granzyme B (e), and EBER based on in situ hybridization (f). Southern blot analysis exhibited EBV terminal repeat (g).
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case_images: Its laboratory examination showed that the number of nucleated cells had decreased (222/muL); however, instead of neutrophils, atypical lymphoid cells accounted for 95% of the nucleated cells (Fig. 4a). Immunohistochemistry revealed that the atypical lymphoid cells were positive for CD3, CD56, TIA1, and granzyme B (Fig. 4b-e), and negative for CD5; furthermore, the Ki-67 index was high. Fluid atypical lymphoid cells were positive for EBER in situ hybridization (Fig. 4f), and they demonstrated EBV terminal repeat (Southern blot analysis) monoclonal patterns (Fig. 4g).