case_images: PMC11079990_01
case_images: Findings from Case 1 at initial onset.. A) PET-CT showed abnormal uptake in the nasal cavity (SUVmax: 14.5).. B) Pathological findings from nasal cavity wherein HE staining revealed proliferation of large abnormal lymphoid cells. Immunohistochemistry was positive for CD3, CD56, and granzyme B. EBER-ISH was positive.. Abbreviations: PET-CT, positron emission tomography-computed tomography; EBER-ISH, EBV-encoded small RNA-in situ hybridization; HE, hematoxylin and eosin.
case_images: jslrt-64-45-g001.jpg
case_images: PMC11079990_01_jslrt-64-45-g001.jpg
case_images: f1
case_images: Positron emission tomography-computed tomography revealed abnormal uptake in the nasal cavity (maximum standardized uptake value [SUV]: 14.5) (Figure 1A). EBV-encoded small RNA-in situ hybridization (EBER-ISH) results were positive (Figure 1B).
case_images: Findings from Case 1 at recurrence.. A) PET-CT revealed new abnormal uptake in the right fibula (SUVmax: 4.2).. B) In the right fibula lesion, MRI revealed T2-weighted hypersignal and T1-weighted fat-suppressed imaging hypersignal enhanced following gadolinium injection.. C) Pathological findings of right fibula wherein HE staining revealed proliferation of abnormal lymphoid cells. Immunohistochemistry was positive for CD3, CD56, and granzyme B.. Abbreviations: PET-CT, positron emission tomography-computed tomography; MRI, Magnetic Resonance Imaging; HE, hematoxylin and eosin.
case_images: jslrt-64-45-g002.jpg
case_images: PMC11079990_01_jslrt-64-45-g002.jpg
case_images: f2
case_images: After induction therapy (radiation therapy and three courses of 2/3 DeVIC; dexamethasone, etoposide, ifosfamide, and carboplatin), PET-CT (the duration from induction therapy completion to PET/CT: 74 days) revealed the loss of abnormal uptake of baseline lesions but new abnormal uptake in the right fibula (SUVmax: 4.2) (Figure 2A). Magnetic resonance imaging of the right fibula lesion revealed that the T2-weighted hypersignal and T1-weighted fat-suppressed imaging hypersignal were enhanced following gadolinium injection (Figure 2B). Immunohistochemistry revealed that the abnormal lymphoid cells were positive for CD3, CD56, and granzyme B, and ENKTL with bone marrow involvement was diagnosed (Figure 2C).
case_images: PMC11079990_02
case_images: Findings from Case 2 at initial onset.. A) PET-CT showed abnormal uptake in the subcutaneous mass of the right medial thigh (SUVmax: 25.8), lymph node (SUVmax: 18.2), and descending colon (SUVmax: 20.0).. B) Pathological findings from the subcutaneous mass of the right medial thigh. HE staining revealed proliferation of abnormal lymphoid cells. Immunohistochemistry was positive for CD3, CD56, and granzyme B. EBER-ISH was positive.. Abbreviations: PET-CT, positron emission tomography-computed tomography; EBER-ISH, EBV-encoded small RNA-in situ hybridization; HE, hematoxylin and eosin.
case_images: jslrt-64-45-g003.jpg
case_images: PMC11079990_02_jslrt-64-45-g003.jpg
case_images: f3
case_images: Positron emission tomography-CT revealed abnormal uptake in the subcutaneous mass of the right medial thigh (SUVmax: 25.8), lymph nodes (SUVmax: 18.2), and descending colon (SUVmax: 20.0) (Figure 3A). EBER-ISH was also positive (Figure 3B).
case_images: Findings from Case 2 at recurrence.. A) PET-CT revealed new abnormal uptake in the left tibia (SUVmax: 10.7).. B) The left tibia lesion on MRI revealed enhanced T1-weighted hyposignal and T1-weighted fat-suppressed imaging hypersignal, following gadolinium injection.. C) Pathological findings from of the left tibia. HE staining revealed proliferation of abnormal lymphoid cells. Immunohistochemistry was positive for CD3 and CD56. EBER-ISH was positive.. Abbreviations: PET-CT, positron emission tomography-computed tomography; EBER-ISH, EBV-encoded small RNA-in situ hybridization; HE, hematoxylin and eosin; MRI, Magnetic Resonance Imaging.
case_images: jslrt-64-45-g004.jpg
case_images: PMC11079990_02_jslrt-64-45-g004.jpg
case_images: f4
case_images: After induction therapy (four cycles of SMILE), PET-CT (the duration from induction therapy completion to PET/CT: 30 days) revealed loss of abnormal uptake of baseline lesions but new abnormal uptake in the left tibia (SUVmax: 10.7) (Figure 4A). T1-weighted hyposignal and a T1-weighted fat-suppressed imaging hypersignal that was enhanced after gadolinium injection (Figure 4B). Thereafter, CT-guided biopsy of the left tibial lesion was performed, and HE staining of the biopsy specimens revealed the proliferation of large abnormal lymphoid cells. Immunohistochemistry revealed that the abnormal lymphoid cells were positive for CD3, CD56, and EBER-ISH (Figure 4C).