case_images: PMC10883764_01
case_images: Transvaginal ultrasound, sagittal view of the uterus.. (A) Transvaginal ultrasound demonstrates an 8-cm retroflexed uterus with increased thickness of the sub-endometrial hypoechoic halo (arrows). (B) Color Doppler demonstrates areas of increased vascularity and small cysts within the endometrium (arrows).
case_images: cureus-0016-00000052815-i01.jpg
case_images: PMC10883764_01_cureus-0016-00000052815-i01.jpg
case_images: FIG1
case_images: Pelvic and transvaginal ultrasound demonstrated an 8-cm retroflexed uterus with increased thickness of the sub-endometrial hypoechoic halo, as well as areas of increased vascularity and small cysts within the endometrium concerning for adenomyosis (Figure 1A, 1B).
case_images: ALK-positive anaplastic large cell lymphoma on H&E stain (40x, 60x, and 100x) and Ki-67 stain.. (A-C) Sheets of large pleomorphic cells and "hallmark cells" are present on H&E stain. These cells have irregular nuclear borders with variable nuclei and inconspicuous nucleoli, along with an abundant eosinophilic cytoplasm. In addition, there is extensive mitotic activity and apoptotic bodies in a background of acute inflammation. (D) Ki-67 stain shows a high proliferation index.. H&E: hematoxylin and eosin
case_images: cureus-0016-00000052815-i02.jpg
case_images: PMC10883764_01_cureus-0016-00000052815-i02.jpg
case_images: FIG2
case_images: The characteristic hallmark cells were also present (Figure 2A-2D).
case_images: Immunohistochemical stains (40x).. The malignant cells show nuclear and diffuse cytoplasmic staining for (A) ALK, membranous and Golgi type staining for (B) CD30, membranous staining for (C) CD43, and cytoplasmic with membranous accentuation staining for (D) CD4. The malignant cells are negative for (E) CD3 and (F) CD20.. ALK: anaplastic lymphoma kinase, CD: cluster of differentiation
case_images: cureus-0016-00000052815-i03.jpg
case_images: PMC10883764_01_cureus-0016-00000052815-i03.jpg
case_images: FIG3
case_images: By immunohistochemistry, the malignant cells were strongly positive for ALK, CD30 (TNF receptor superfamily member 8), CD10 (neutral endopeptidase), cluster of differentiation 4 (CD4), and CD43 (leukosialin or sialophorin) (Figure 3A-3F).
case_images: MRI of the pelvis, sagittal view.. MRI of the pelvis demonstrates a (A, arrow) heterogeneous T2 hypointense region in the endometrium measuring 2.2 cm in thickness with areas of T2 hypointensity. (B, arrow) Intermediate T2 hyperintense sub-endometrial soft tissue surrounding the endometrial stripe, extending into the endocervical canal, and distending the vaginal cavity.. MRI: magnetic resonance imaging
case_images: cureus-0016-00000052815-i04.jpg
case_images: PMC10883764_01_cureus-0016-00000052815-i04.jpg
case_images: FIG4
case_images: PET/CT, MRI pelvis, lactate dehydrogenase (LDH), and bone marrow biopsy (Figure 4). PET/CT demonstrated nodal lesions above and below the diaphragm, and several extranodal sites, including pulmonary, mediastinal, liver, uterine, cervix, and T10 vertebra with an associated compression fracture.