case_images: PMC9768801_01
case_images: BM biopsy results. BM biopsy showed diffuse involvement by a small lymphocytic infiltration ((A), HE, 40x). Presence of numerous small lymphocytes and scattered paraimmunoblasts in the infiltrated tissues ((B), HE, 400x). The tumor cells were positive for CD20 ((C), Enlivision, 400x), CD23 ((D), Enlivision, 400x), and CD5 ((E), Enlivision, 400x).
case_images: pore-28-1610653-g001.jpg
case_images: PMC9768801_01_pore-28-1610653-g001.jpg
case_images: F1
case_images: BM biopsy showed a markedly hypercellular marrow (85%), which was diffusely involved by a small lymphocytic infiltration (80%) (Figure 1A). The infiltration consisted of numerous small lymphocytes and scattered paraimmunoblasts (Figure 1B). The tumor cells were positive for CD20, CD5, and CD23, and were negative for CD3, CD10, TdT, and cyclin D1 (Figures 1C-E).
case_images: CT scan and enteroscope of the patient. CT enterograph of the small intestine showed even thickening in the wall of the small intestine (jejunum) in the pelvic cavity with multiple lymphadenopathy in enterocoelia and retroperitoneum ((A), arterial phase; (B), portal phase; (C), lag phase). Enteroscopic examination showed multiple ulcers in the distal jejunum (D). The ulcers were deeper with irregular margins and were covered with white pus moss. Enteroscopic examination showed stenosis in the jejunum (E).
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case_images: PMC9768801_01_pore-28-1610653-g002.jpg
case_images: F2
case_images: CT enterography showed thickening in the small intestinal wall (Figures 2A-C), together with multiple lymphadenopathies in the abdominal cavity and retroperitoneum. Enteroscopic examination indicated multiple ulcers in the distal jejunum, which were deeper in site with an irregular margin covering them with white pus moss (Figures 2D,E).
case_images: Composite CLL/SLL and MEITL. Microscopically, the intestinal wall was diffusely infiltrated by the neoplastic lymphocytes ((A), HE, 8x). The villous architecture was distorted and the neoplastic cells showed prominent epitheliotropism ((B,C), HE, 100x). The cells were generally medium in size with a generous rim of the pale cytoplasm. The nuclei were irregular, and most of them had finely dispersed chromatin and inconspicuous nucleoli. ((C), HE, 400x) CLL/SLL tumor cells were found around the blood vessels in the intestinal wall at the periphery of the tumor ((D), HE, 200x). The MEITL tumor cells in the mass were positive for CD3 ((E), Enlivision, 200x), negative for CD5 (F), Enlivision, 200x) and CD4 ((G), Enlivision, 200x), positive for CD8 ((H), Enlivision, 200x), CD56 ((I), Enlivision, 200x), TIA-1 ((J), Enlivision, 200x) and Granzyme B ((K), Enlivision, 200x). The Ki-67 index of MEITL was in a range of approximately 70%-80% ((L), Enlivision, 200x). The CLL/SLL tumor cells in the mass were positive for CD20 ((M), Enlivision, 200x), CD23 ((N), Enlivision, 200x), and CD5 ((O), Enlivision, 200x). The Ki-67 index of CLL/SLL were about 5%-10% ((P), Enlivision, 200x).
case_images: pore-28-1610653-g003.jpg
case_images: PMC9768801_01_pore-28-1610653-g003.jpg
case_images: F3
case_images: The villi were broadly expanded and infiltrated by the tumor cells, presenting prominent epitheliotropism in the peripheral intestine (Figures 3A-C). Additionally, small lymphoid cells were seen around the blood vessels in the intestinal wall (Figure 3D). The Ki-67 index was in a range of 70%-80% (Figures 3E-L). The Ki-67 index was in a range of 5%-10% (Figures 3M-P).