PMC6234446_01
(a) CT of both lungs detects multifocal nodular lesions with ground-glass shadows. (b) PET detects abnormal uptake in multifocal lung lesions and the gastric body. (c) Before treatment, gastroscopy reveals an ulcerative lesion in the gastric body. (d) After treatment, gastroscopy shows improvement of the gastric lesion.
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Chest X-ray and computed tomography (CT) showed consolidation and surrounding ground-glass shadows in both lungs (Figure 1(a)), and transbronchial lung biopsy was therefore performed. Positron emission tomography (PET)/CT was performed to search for other lesions, revealing abnormal uptake in the stomach in addition to the lung lesions (Figure 1(b)). Gastroscopy showed an ulcerative lesion (Figure 1(c)) that was biopsied. After two courses of chemotherapy, gastrointestinal endoscopy showed shrinkage of the ulcerative lesion (Figure 1(d)) and elimination of lymphoid cells in the biopsy.
Pathological examinations of the lung (a-e) and gastric (f-j) lesions. (a, f) 100x magnification; (b, g) 400x magnification; other images 200x magnification. (a, b, f, g) Hematoxylin and eosin staining; (c-e, h-j) immunohistochemical staining. (a, b) Multiple lesions in the lungs show destruction of the pulmonary lobes and replacement with large tumor cells. (c) Tumor cells appear CD3-positive. (d) Tumor cells appear CD20-negative. (e) Tumor cells appear EBER-positive. (f, g) In the gastric lesion, tumor cells have infiltrated the mucosal epithelium. (h) Tumor cells appear CD3-negative. (i) Tumor cells appear CD20-positive. (j) Tumor cells appear EBER-negative.
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Tumor cells showed expressions of CD3, CD4, CD56, TIA-1, and granzyme B and in situ hybridization for Epstein-Barr virus- (EBV-) encoded small RNA (EBER-ISH), but absence of CD5, CD8, CD10, and CD20, leading to the diagnosis of ENKL (Figures 2-2). Tumor cells lacked expressions of CD3, CD5, CD10, CD56, bcl2, bcl6, and EBER-ISH and positive results for CD20, CD79a, and MUM1, leading to the diagnosis of DLBCL (nongerminal center B-cell-like type) (Figures 2-2).