case_images: PMC5061930_01
case_images: Computed tomography demonstrating diffuse axillary lymphadenopathy measuring 1 to 1.2 cm in short axis (a) and ascites (b).
case_images: CRIHEM2016-4703608.001.jpg
case_images: PMC5061930_01_CRIHEM2016-4703608.001.jpg
case_images: fig1
case_images: Computed tomography demonstrated diffuse axillary lymphadenopathy (1 to 1.2 cm in diameter), hepatomegaly, and anasarca (Figures 1(a) and 1(b)).
case_images: Biopsy of left axillary lymph node demonstrating (a) well-developed germinal centers with round to ovoid to slightly irregular contours, (b) small atrophic germinal centers, (c) depleted of PAX-5 positive B lymphoid cells with very low proliferation (d) rates using MIB-1 antibody.
case_images: CRIHEM2016-4703608.002.jpg
case_images: PMC5061930_01_CRIHEM2016-4703608.002.jpg
case_images: fig2
case_images: Biopsy of the left axillary lymph nodes was remarkable for scattered secondary lymphoid follicles variable in size, some with well-developed germinal centers with round to ovoid to slightly irregular contours to a few secondary lymphoid follicles with small atrophic germinal centers (Figures 2(a) and 2(b)) depleted of B lymphoid cells (Figure 2(c), PAX-5 antibody) and with very low proliferation rates (Figure 2(d), MIB-1 antibody).
case_images: Biopsy of left axillary lymph node, with increased numbers of MUM1 positive plasma cells in the interfollicular areas ((a) objective 50x) and with a high proliferation rate ((b) MIB-1 antibody, objective 500x). EBER in situ hybridization stain with increased subset of positive cells in the interfollicular area ((c) objective 500x).
case_images: CRIHEM2016-4703608.003.jpg
case_images: PMC5061930_01_CRIHEM2016-4703608.003.jpg
case_images: fig3
case_images: There was interfollicular polytypic plasmacytosis, composed mostly of mature-appearing MUM1 positive plasma cells (Figure 3(a)) associated with a high proliferation rate (Figure 3(b), MIB-1 antibody), and there was a subset of lymphoid cells in the interfollicular region with predominant cytoplasmic positivity for EBER in situ hybridization (Figure 3(c)).
case_images: PCR gel for detection of EBV DNA: samples 1 and 2 are two replicates of patient's DNA with different amounts of sample; M is the 100 bp ladder molecular weight marker. PC, positive control; NC, negative control; NTC, no template control (a). Hypercellular bone marrow biopsy ((b) hematoxylin and eosin stain 50x, immersion oil) and aspirate ((c) Wright Giemsa stain, 100x, immersion oil) with trilineage hematopoiesis; a small hypolobated megakaryocyte ((c) inset).
case_images: CRIHEM2016-4703608.004.jpg
case_images: PMC5061930_01_CRIHEM2016-4703608.004.jpg
case_images: fig4
case_images: T-cell receptor beta and gamma gene rearrangements but detected the presence of EBV DNA sequences (Figure 4(a)). The above findings are in keeping with an atypical lymphoid hyperplasia with features of a mixed type of Castleman disease. Patient's bone marrow examination was remarkable for hypercellularity with trilineage hematopoiesis (Figure 4(b)) with mild dyserythropoiesis (Figure 4(c)) and dysmegakaryopoiesis (Figure 4(c) inset) but was associated with reported normal 46, XY karyotype.