PMC3422903_01
Trichrome stain showing portion of well-preserved muscle (upper left), and an area of markedly atrophic muscle, with extensive fibrosis (lower right).
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Discrete areas of severe interstitial fibrosis and fatty replacement were juxtaposed to areas of nearly intact muscle (Figure 1; Trichrome stain, low magnification).
ATP-ase stain showing loss of normal checker-board pattern of muscle fibers, with large groups of type I and type II fibers, diagnostic of denervation/reinnervation.
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Triphosphatase stain showed prominent fiber-type grouping in the areas with preserved fibers (Figure 2), consistent with a chronic neuropathic pattern of denervation with reinnervation. There was no significant endomysial, perimysial, or perivascular inflammation, and no findings diagnostic of an underlying specific myopathic or dystrophic process.
A small interstitial lymphoid aggregate is identified (magnification, 100x).
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The examination of the bone marrow biopsy revealed small interstitial lymphoid aggregate (Figure 3).
Monomorphous small lymphocytes with scant pale cytoplasm and condensed chromatin (magnification, 400x).
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The cells within the aggregate were composed of monomorphous small lymphocytes with scant pale cytoplasm and condensed chromatin (Figure 4).
CD5 positivity (magnification, 400x).
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Most significantly, the immunophenotype of the lymphoid aggregate expressed CD5 (Figure 5), CD20 (Figure 6), and CD23 (Figure 7), positivity, which was consistent with CLL immunophenotype.
CD20 positivity (magnification, 400x).
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Most significantly, the immunophenotype of the lymphoid aggregate expressed CD5 (Figure 5), CD20 (Figure 6), and CD23 (Figure 7), positivity, which was consistent with CLL immunophenotype.
CD23 positivity (magnification, 400x).
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Most significantly, the immunophenotype of the lymphoid aggregate expressed CD5 (Figure 5), CD20 (Figure 6), and CD23 (Figure 7), positivity, which was consistent with CLL immunophenotype.