PMC6251325_01
Enhanced-CT of abdomen: diffusible thickening mucosa of ascending, transverse and descending colon with coarse rims, uneven enhancement in artery phase (Red arrow) (A). Image of Venous phase (Red arrow) (B). Multiple lymph nodes could be seen in mesenteric and posterior-peritoneum areas.
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F1
Multiple lymph nodes of mesenteric and posterior-peritoneum areas were visible (Figure 1).
Preoperative colonoscopy manifestation: an ulceration with clear rim and base revealed in ileum terminal (A). Preoperative colonoscopy revealed multiple and discrete ulcers as visible in different segment of Colon (B-E) and Rectum (F).
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F2
Normal mucosa was also clearly visible amid the ulcers (Figure 2).
Slides from the resected colon showed ulceration of intestinal mucosa and intestinal interstitial edema (A-D) along with diffused infiltration of small-to medium-sized pleomorphic mild atypical lymphoid cells within mucosa and submucosa with a mixture of plasma cells and eosinophilic granulocyte and tissue cells (C,D). Some lymphoid cells had big nucleus and obvious nucleoli (D). Lymphoid cells were distributed in muscular layer and serosa (A,B).
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F3
Lymphoid cells were observed to be distributed in muscular layer and serosa (Figure 3).
(A) Immunohistochemistry revealed a large number of atypical lymphoid cells expressing CD2 (A: 20X10), CD3 (B: 20X10), CD4(C: 20X10) and CD7 (E: 20X10). CD5 (D: 20X10)-positive cells were less than CD3-positive cells; CD8 (F: 20X10)-positive cells were less than CD4-positive cells and CD20 (G: 20X10)-positive cells presented a focal distribution. Granzyme B (H: 20X10)-positive cells were scattered. There was partial positivity for TIAI (J: 20X10), TCRGbeta, and TCRgammadelta. Cells were negative for CD56 and Ki-67 (I: 20X10)-positivity was 40-50%. (B) EBV in situ hybridization for EBV encoded mi-RNA (EBER) demonstrated EBV-positive (50/HPF) atypical lymphoid cells (K: 20X10).
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F4
IHC revealed that the mild atypical lymphoid cells were positive for (Figure 4B) CD3, (Figure 4A) CD2, (Figure 4E) CD7, and (Figure 4C) CD4 expression. TIAI, TCRGbeta, and TCRgammadelta. The lymphoid cells were negative for CD56. (Figure 4I) Ki-67 positivity was 40-50%. In situ hybridization for (Figure 4K) EBER demonstrated EBV-positive atypical lymphoid cells of 50/HPF.
Multiple Aphthous bleeding ulcers scatted from the stoma to 40 cm away of small intestine (black arrow) (A); Colonic post-operative anastomositis (B).
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F5
A post-operative colonoscopy, performed at first relapse, showed multiple aphthous bleeding ulcers scattered from the stoma to about 40 cm away from small intestine, in addition to colonic post-operative anastomositis (Figure 5).
No ulceration or neoplasm was found in Endoscopy. Post-operation changes in small intestine (A,B).
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F6
Moreover, nothing remarkable was observed in colonoscopy this time (Figure 6).