case_images: PMC10601740_01
case_images: a Lymphocytes and smudge cells in PB, objective x20. b Atypical small-to-intermediate-sized mature lymphocytes in PB, objective x60. c Bone marrow infiltration by small lymphocytes with minimal cytoplasm, condensed nuclear chromatin, and indistinct nucleoli, objective x20. d Bone marrow: small lymphocytes express CD3 positivity, objective x20.
case_images: cro-2023-0016-0001-531592_F01.jpg
case_images: PMC10601740_01_cro-2023-0016-0001-531592_F01.jpg
case_images: F1
case_images: A PB smear revealed multiple smudge cells (shown in Fig. 1 a) and atypical, small-to-intermediate-sized mature lymphocytes (shown in Fig. 1 b). A bone marrow aspiration and biopsy showed diffuse interstitial and intrasinusoidal infiltration by small lymphocytes with minimal cytoplasm, condensed nuclear chromatin, and indistinct nucleoli (shown in Fig. 1 c).
case_images: Chest X-ray showing right-sided pleural effusion, extensive lung consolidation, and patchy ground glass on the right side with air bronchograms throughout the right lower lobe.
case_images: cro-2023-0016-0001-531592_F02.jpg
case_images: PMC10601740_01_cro-2023-0016-0001-531592_F02.jpg
case_images: F2
case_images: She developed profound fatigue, dyspnea, and progression of a skin rash, pleural effusions (shown in Fig. 2), and ascites, dysphagia, and new abdominal pain.
case_images: CT abdomen: hepatosplenomegaly and enlarged upper abdominal adenopathy.
case_images: cro-2023-0016-0001-531592_F03.jpg
case_images: PMC10601740_01_cro-2023-0016-0001-531592_F03.jpg
case_images: F3
case_images: Computerized tomography (CT) scan showed hepatosplenomegaly (spleen size 15 x 10 cm) (shown in Fig. 3) and multiple enlarged lymph nodes above and below the diaphragm.
case_images: CT chest: bulky bilateral hilar and mediastinal adenopathy and loculated pleural fluid located posterolaterally on the right.
case_images: cro-2023-0016-0001-531592_F04.jpg
case_images: PMC10601740_01_cro-2023-0016-0001-531592_F04.jpg
case_images: F4
case_images: Some of the individual lymph nodes measured at least 3.5 x 2 cm in diameter; however, the confluence measured several centimeters (shown in Fig. 4).