case_images: PMC6528141_01
case_images: Systemic computed tomography (CT) scan images on admission.. Systemic CT scan showed lymphadenopathies at (A) right neck, right
  supraclavicular, superior mediastinal, and right axillary lymph nodes;
  (B) under tracheal branch; and (C) under tracheal
  branch. Evident neoplastic bone lesions were not found.
case_images: jslrt-59-22-g001.jpg
case_images: PMC6528141_01_jslrt-59-22-g001.jpg
case_images: f1
case_images: Evident neoplastic bone lesions were not found (Figure 1).
case_images: Pathological images of cervical lymph node biopsy on the 5th hospital day.. Hematoxylin-eosin (HE) staining showed large atypical lymphocytes growing in the
  tissue. Immunostaining revealed that tumor cells were CD3(-), CD20(-), CD4(+), CD8(-),
  CD30(+), ALK(-), TIA-1(+), PAX5(-), CD68(-), AE1/AE3(-) and Granzyme B(-). CD68-positive
  histiocytes were observed around the tumor cells.
case_images: jslrt-59-22-g002.jpg
case_images: PMC6528141_01_jslrt-59-22-g002.jpg
case_images: f2
case_images: CD68-positive cells, which were considered to be macrophage- or monocyte-like cells, were observed in the microenvironment of tumor cells (Figure 2). Chromosomal abnormalities could not be detected from G-banding because enough metaphase cells were not obtained.
case_images: Transition of lactate dehydrogenase (LDH), soluble interleukin-2 receptor (sIL2-R),
  corrected serum calcium (corrected Ca), and 1,25-dihydroxyvitamin
  D3
  (1,25(OH)2D3).. Corrected Ca and 1,25(OH)2D3 are improved
  in parallel with LDH and sIL2-R. Day 1 is the date of hospitalization. THP:
  therarubicin, CPA: cyclophosphamide, VCR: vincristine, PSL: prednisolone, PA: partial
  response, CR: complete response.
case_images: jslrt-59-22-g003.jpg
case_images: PMC6528141_01_jslrt-59-22-g003.jpg
case_images: f3
case_images: His general condition was improving, and his corrected serum calcium and 1,25(OH)2D3 returned to the normal range, along with decreases in LDH and soluble interleukin-2 receptor (sIL2-R) levels (Figure 3).
case_images: 18F-fluorodeoxy glucose positron emission tomography (FDG-PET) images after
  6th cycle of THP-COP therapy.. FDG-PET showed that lymphadenopathy at (A) right neck, right
  supraclavicular, superior mediastinal, and right axillary lymph nodes;
  (B) subcarinal lymph nodes; and (C) pancreas head
  had disappeared. No significant accumulations of FDG were observed (D).
  We confirmed complete metabolic response.
case_images: jslrt-59-22-g004.jpg
case_images: PMC6528141_01_jslrt-59-22-g004.jpg
case_images: f4
case_images: We confirmed complete metabolic response by 18F-fluorodeoxy glucose positron emission tomography at the end of the 6th cycle (Figure 4).