case_images: PMC10158724_01
case_images: A whole-body computed tomography (CT) shows a right retroperitoneal mass without cervical, axillary, and para-aortic lymphadenopathy (A-C; red arrow). A whole-body CT reveals small cervical, axillary, and para-aortic lymphadenopathy (D-F; red arrows). Positron emission tomography-CT taken during slightly progressive cervical lymphadenopathy shows the increased uptake of fluorodeoxyglucose at the same sites (G-I; red arrows). A whole-body CT shows no exacerbation of cervical, axillary, and para-aortic lymphadenopathy for one and a half years after diagnosis of nodal peripheral T-cell lymphoma with T follicular helper phenotype (J-L; red arrows)
case_images: jslrt-63-37-g001.jpg
case_images: PMC10158724_01_jslrt-63-37-g001.jpg
case_images: f1
case_images: In addition, a year prior to his presentation to our institute, a right retroperitoneal mass without cervical, axillary, and para-aortic lymphadenopathy was incidentally detected on a whole-body computed tomography (CT) on a follow-up visit after surgery for lung cancer (Fig. 1A-C). A whole-body CT revealed small cervical, axillary, and para-aortic lymphadenopathy, but the known right retroperitoneal mass had spontaneously resolved. (Fig. 1D-F). PSL treatment, cervical lymphadenopathy had slightly progressed without other clinical symptoms. Positron emission tomography-CT showed increased fluorodeoxyglucose uptake in systemic enlarged lymph nodes (Fig. 1G-I). However, his lymphadenopathy did not progress (Fig. 1J-L), and he had no recurrence of thrombocytopenia and no appearance of lymphoma-related symptoms for one and a half years after diagnosis with PSL dose: 10 mg daily continuation.
case_images: Hematoxylin and eosin (H & E) staining of the left cervical lymph nodes shows the dense proliferation of medium-sized lymphoid cells between enlarged follicles (A, x400). The medium lymphoid cells are CD4+ (B, x400), programmed cell death-1+ (C, x400), and inducible T-cell co-stimulator+ (partially) (D, x400). The formation of follicular dendritic cell meshwork is limited in follicles on CD21 staining (E, x20). Epstein-Barr virus-encoded small RNA in situ hybridization reveals scattered positive cells (F, x400). A pathological review of the CT-guided biopsy specimens from the right retroperitoneal mass reveals a dense infiltrate of small-to-medium-sized lymphocytes with germinal centers on H & E staining (G, x400). A large number of CD4+ and PD-1+ T-cells were found outside the follicles (H, I, x400)
case_images: jslrt-63-37-g002.jpg
case_images: PMC10158724_01_jslrt-63-37-g002.jpg
case_images: f2
case_images: Histological examination of the biopsy specimen using hematoxylin and eosin (H & E) staining revealed the dense proliferation of medium-sized lymphoid cells between enlarged follicles (Fig. 2A). T-cell co-stimulator+ (partially) on immunohistochemistry (Fig. 2B-D). These tumor cells proliferated around the residual non-neoplastic germinal centers where follicular dendritic cell meshwork (CD21+ area) was maintained (Fig. 2E), showing a "T-zone pattern". Ki-67 labeling index was high (data not shown) and in situ hybridization for EBV-encoded small RNA revealed scattered positive cells (Fig. 2F). T-cells outside the follicles (Fig. 2G-I).