case_images: PMC9038153_01
case_images: Representative of patient's PET imaging. (A and B) PET scan images revealed that FDG uptake was high in multiple lymph nodes (SUV max: 9.4) and bones (SUV max: 6.2), posterior wall of nasopharynx (SUV max: 6.5), bilateral ethmoid sinuses (SUV max: 5.0), bilateral testicle and right spermatic cord (SUV max: 7.3) and subcutaneous nodules on bilateral cheeks (SUV max: 2.8) before therapy. (C and D) PET/CT evaluation was carried out before Protocol M of CCCG-LBL-2016 beginning, and it showed complete remission. (E and F) Repeat PET/CT scan more than five months after transplantation showed normal metabolic activity. FDG, fluorodeoxyglucose; PET, positron emission tomography.
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case_images: There was also mildly increased metabolic activity in the subcutaneous nodules on the bilateral cheeks (SUV max: 2.8) (Figure 1A and B). Immunohistochemical staining showed that representative B lymphoblastic tumor cells were positive for CD20 and terminal deoxynucleotidyl transferase (TdT) and negative for CD3, and approximately 90% of the neoplastic cells displayed nuclear Ki67 staining (Figure S1). Ph+ B-LBL, a combination of dasatinib (140mg, qd) was added to therapeutic regimen. PET/CT evaluation was carried out before Protocol M of CCCG-LBL-2016 began, and it showed complete remission (CR) (Figure 1C and D), Protocol M (5 g/m2 methotrexate and 6-mercaptopurine) combined with dasatinib proceeded as planned for 4 cycles. Sustained complete chimerism and negative BCR/ABL1 detection, along with recent PET/CT results (Figure 1E and F), indicated a satisfactory CR for more than 1 year.
case_images: Morphologic features of the skin lesion. (A) The core needle biopsy specimen is extensively replaced with tumor cells characterized by nucleoli and scant cytoplasm (H&E, 400x). (B-D) Immunohistochemical stains show that tumor cells were positive for CD20 ((B), 100x), PAX5 ((C), 100x), and TdT ((D), 100x). (E) Immunohistochemical stains show that tumor cells were negative for CD34 (100x). (F) About 90% of the neoplastic cells display nuclear Ki67 staining (100x). TDT, terminal deoxynucleotidyl transferase.
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case_images: TDT, CD10, CD38, C-MYC, CD99, BCL-2 and CD43, but negative for CD3, CD34, CD7, BCL-6, MPO and MUM1, and Ki67 staining about 90% (Figure 2). Therefore, the diagnosis of B-LBL (Ann Arbor stage IIIA, IPI 3 scores) was confirmed.
case_images: FISH analysis was approached on suspension samples in interphase cells of fresh swelling lymph node specimen using commercial probe (LSI BCR/ABL DS probe, Vysis). (A) Cells with a signal pattern of 1 red, 1 green, and 2 yellow (fusion signal) are positive for BCR/ABL1 rearrangement. (B) Cells with 2 red and 2 green are normal. FISH, Fluorescence in situ hybridization.
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case_images: BCR-ABL1 fusion transcripts were detected approximately 3 weeks after chemotherapy. Based on these results, we retrospectively validated BCR/ABL1 rearrangement in previous lymph node biopsy specimens by fluorescence in situ hybridization (FISH), which detected a 70% positive signal (Figure 3).