case_images: PMC6311313_01
case_images: H&E. Large neoplastic lymphoid cells with hyperchromatic nuclei and coarse chromatin are present within the small blood vessels in thyroid ((a), 10X; (b), 40X), lung ((c), 10X), omentum ((d), 20X), and gall bladder ((e), 10X).
case_images: CRIPA2018-5140586.001.jpg
case_images: PMC6311313_01_CRIPA2018-5140586.001.jpg
case_images: fig1
case_images: Upon microscopic examination, numerous large atypical lymphoid cells were found within the lumen of several small blood vessels of the thyroid gland (Figures 1(a) and 1(b)), lungs (Figure 1(c)), omentum (Figure 1(d)), gallbladder (Figure 1(e)), peripancreatic tissue, and pericolonic fat. These cells were large in size, with round to somewhat irregular hyperchromatic nuclei with occasional prominent nucleoli (Figure 1(b)).
case_images: Immunohistochemical studies performed on thyroid gland revealed that the neoplastic lymphoid cells are positive for CD20 ((a), 20X), dim CD79a ((b), 20X), MUM1 ((c), 20X), and CD5 ((d), 20X); negative for CD10 ((e), 20X), HHV8 ((f), 10X), EBER ((g), 10X), c-MYC, BCL6, and cyclin D1 (not shown).
case_images: CRIPA2018-5140586.002.jpg
case_images: PMC6311313_01_CRIPA2018-5140586.002.jpg
case_images: fig2
case_images: CD20 (Figure 2(a)), dim CD79a (Figure 2(b)), and dim PAX-5 and also positive for MUM-1 (Figure 2(c)), CD5 (Figure 2(d)), and dim CD30. CD10 (Figure 2(e)), BCL-2, c-MYC, HHV8 (Figure 2(f)), BCL-6, CD3, CD138, and cyclin-D1 were negative. Epstein Barr virus (EBV)-encoded small RNAs (EBER) by in situ hybridization was negative (Figure 2(g)).