PMC9638041_01
Diagnosis and treatment process of the patient. (AITL, angioimmunoblastic T-cell lymphoma; FDC, follicular dendritic cell; FRC, fibroblastic reticular cell).
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A 40-45-year-old woman arrived for consultation with facial swelling that affected eating and breathing as well as the palpable "nodules" in both groins in June 2017.  Figure 1  summarizes the important events of this patient according to the timeline. Figure 1 ). First, she received CHOP (cyclophosphamide,
Representative H&E-stained images of the patient's right inguinal lymph node. (A) Cell hyperplasia and perinodal infiltration. (B) Vortex distribution of spindle cells. (C) Medium-sized lymphoid tumor cells with mild atypia, unclear cell boundary, and abundant pale cytoplasm. Abundant branching of high endothelial small vessels, mixed with (D) small lymphocytes and plasma cells, (E) eosinophils and neutrophils, and (F) few scattered large immunoblastic cells. (H&E, Eosin & Hematoxylin).
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The normal structure of the lymph node was effaced ( Figure 2A ), with hyperplasia of several kinds of cells and perinodal infiltration. In most of the areas, the proliferation of spindle cells was dominant, with vortex distribution ( Figure 2B ). Some areas were dominated by medium-sized lymphoid tumor cells with mild atypia, unclear cell boundary, and abundant pale cytoplasm ( Figure 2C ). Affluent branching of high endothelial small vessels, mixed with small lymphocytes, plasma cells ( Figure 2D ), eosinophils, and neutrophils was seen in the background ( Figure 2E ), together with few scattered large immunoblastic cells ( Figure 2F ).
Representative IHC staining images of spindle cells. Spindle cells were positive for (A) CD21, (B) CD23, (C) CD35, (D) desmin, and (E) SMA. (IHC, immunohistochemistry; SMA, smooth muscle actin).
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The immunohistochemistry (IHC) staining demonstrated that the spindle cells were positive for complement C3d receptor 2 (CD21) ( Figure 3A ), CD23 ( Figure 3B ), CD35 ( Figure 3C ), and desmin ( Figure 3D ) and partially positive for SMA ( Figure 3E ).
Representative IHC staining images and detection of clonal rearrangement of the TCR gene in lymphoid tumor cells. Lymphoid tumor cells were positive for (A) CD3, (B) CD10, (C) PD-1, and (D) CXCL13. (E, F) Lymphoid tumor cells were positive for Ki-67, while most of the spindle cells were negative for Ki-67 staining. (G) A few scattered immunoblastic large cells were positive for EBER. (H) Clonal rearrangement of TCRbeta was observed. (IHC, immunohistochemistry; TCR, T cell receptor; PD-1, programmed cell death 1; CXCL13, C-X-C motif chemokine ligand 13; EBER, Epstein-Barr virus encoded small RNA).
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T cell receptor, bF1 (TCRbF1) and negative for CD20, CD8, and T cell receptor, g (TCRg). The Ki-67 index of the tumor cells was about 60%, while majority of the spindle cells were negative for Ki-67 staining ( Figures 4E, F ). In situ hybridization for Epstein-Barr virus (EBV)-encoded small RNA (EBER) showed that a few scattered immunoblastic large cells were positive for EBER ( Figure 4G ). Clonal rearrangement of TCRbeta gene was detected ( Figure 4H ).