case_images: PMC7105335_01
case_images: Patient 1, bone marrow biopsy with AITL: (A) Focal, interstitial marrow involvement with monomorphic population of small to medium-sized lymphoid cells with moderately abundant pale eosinophilic cytoplasm, H&E, 100x. (B) PD-1, 100x. (C) EBER ISH, 400x.
case_images: can-14-1011fig1.jpg
case_images: PMC7105335_01_can-14-1011fig1.jpg
case_images: figure1
case_images: Her bone marrow biopsy found atypical lymphoid aggregates that contained a mixed population of T-cells positive for CD3, CD5 and PD1, and B-cells positive for CD20 and variably positive for PAX-5 and BCL6 (Figure 1; Table 1).
case_images: Patient 1, axillary lymph node with AITL: (A) Prominent vascular proliferation of high endothelial venules (HEVs) and nodal architecture effacement by a monomorphic lymphoid population, H&E, 100x. (B) Neoplastic population of follicular helper T cells with small to medium-sized nuclei and clear-to-pale cytoplasm, especially clustering adjacent to HEVs, and scattered CD30+ immunoblasts (circled, IHC not shown). H&E, 400x. (C) Increased numbers of T cells in effaced areas, especially perivascular T cells, CD3, 100x. (D) Increased numbers of neoplastic follicular helper T cells, PD-1, 100x. (E) Expanded dendritic meshwork, CD21, 100x. (F) EBER in situ hybridisation (EBER ISH) positive neoplastic T cells, 100x.
case_images: can-14-1011fig2.jpg
case_images: PMC7105335_01_can-14-1011fig2.jpg
case_images: figure2
case_images: Excisional axillary lymph node biopsy had immunostaining positive for CD2, CD3, CD5, CD7 and CD4 PD-1, and negative for CD30 in the lesional T-cells, consistent with AITL (Figure 2; Table 1).
case_images: PMC7105335_02
case_images: Patient 2, axillary lymph node with AITL: (A) Partial nodal architecture effacement by a monomorphic lymphoid population and increased numbers of eosinophils, H&E, 100x. (B) Neoplastic population of monomorphic follicular helper T cells with small to medium-sized nuclei and clear-to-pale cytoplasm in a polymorphous background of neutrophils and increased numbers of eosinophils with scattered CD30+ immunoblasts (circled, IHC not shown), H&E, 400x. (C) Increased numbers of neoplastic helper T cells, CD4, 100x. (D) Increased numbers of neoplastic follicular T helper cells (dim) with scattered neutrophils (strong), CD10, 100x. (E) Increased numbers of neoplastic helper T cells, PD-1, 100x. (F) Expanded dendritic meshwork, CD23, 100x.
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case_images: PMC7105335_02_can-14-1011fig3.jpg
case_images: figure3
case_images: His axillary lymph node biopsy with immunostaining was positive for CD2, CD3, CD4, CD5, CD7, CD10 (subsets), BCL-6 and PD-1 in the lesional T-cells, consistent with AITL (Figure 3; Table 1).
case_images: PMC7105335_03
case_images: Patient 3, cervical lymph node with T-ALL. (A) Relatively monomorphic infiltrate of neoplastic lymphocytes with irregularly shaped, hyperchromatic, small to medium-sized nuclei with inconspicuous nucleoli, 400x. (B) CD34-negative, (CD34-positive blood vessels as internal control), 100x. (C) CD10-negative, 100x. (D) TdT-positive (nuclear), 100x. (E) CD1a-positive, 100x. (F) Ki-67 with 80% proliferation index, 100x.
case_images: can-14-1011fig4.jpg
case_images: PMC7105335_03_can-14-1011fig4.jpg
case_images: figure4
case_images: His excisional cervical lymph node biopsy immunophenotype stained positive for Tdt, CD1a, CD2, CD7, cytoplasmic CD3, CD33 and CD34, and was negative for surface CD3 and MPO in the lesional T-cells, compatible with the diagnosis of T-ALL (Figure 4; Table 1).