PMC6287990_01
Cervical non-contrast computed tomography (a) and cervical non-contrast T2-weighted magnetic resonance imaging (b) scans revealing left cervical lymphadenopathy. The area of lymphadenopathy is circled.
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Computed tomography and magnetic resonance imaging scans of the body and neck were immediately taken and revealed left cervical and supraclavicular lymphadenopathy (Fig. 1a and b).
In July 200X+9, an ulcerative lesion was found in the lesser curvature of the stomach by esophagogastroduodenoscopy (a, b). Seven months after the cessation of methotrexate, scarring of the previous ulcerative lesion was confirmed by esophagogastroduodenoscopy (c, d).
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In July 200X+7, follow-up EGD for the examination of the gastric ulcer revealed an ulcerative lesion at the lesser curvature of the stomach (Fig. 2a and b). In February 200X+8, at 7 months after the first EGD procedure, a second EGD procedure revealed scarring at the previous site of the ulcerative lesion (Fig. 2c and d).
Lymphoid cell infiltration in the lamina propria with Hematoxylin and Eosin staining in a low-power field (a: x40), b middle-power field (b: x100) and high-power field (c: x400). Scale bar indicates 20 mum (a), 50 mum (b), and 200 mum (c), respectively.
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Biopsy specimens of the ulcerative lesion showed lymphoid cell infiltration into the lamina propria (Fig. 3a-c) In these specimens, CD20-positive (Fig. 4a) and CD79alpha-positive (Fig. 4b) B lymphocytes were predominant, while CD3-positive T lymphocytes (Fig. 4c) and CD5-positive T lymphocytes (Fig. 4d) were less predominant.
Immunohistochemistry of the biopsy specimen obtained from the ulcerated lesion. CD20 (a), CD79alpha (b), CD3 (c), CD5 (d), CD10 (e), CD21 (f),kappa light chain (g) and lambda light chain staining (h). All scale bars indicate 100 mum. The magnification of these images is x200.
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Biopsy specimens of the ulcerative lesion showed lymphoid cell infiltration into the lamina propria (Fig. 3a-c) In these specimens, CD20-positive (Fig. 4a) and CD79alpha-positive (Fig. 4b) B lymphocytes were predominant, while CD3-positive T lymphocytes (Fig. 4c) and CD5-positive T lymphocytes (Fig. 4d) were less predominant. Moreover, the specimens were CD 10- and CD 21-negative (Fig. 4e and f). The kappa/lambda ratio of the B lymphocytes showed no dissociation (Fig. 4g and h).
In situ hybridization to detect the the Epstein-Barr encoding region (EBER) indicated the Epstein-Barr virus in infiltrating lymphocytes. EBER-positive cells are circled. The scale bar indicates 200 mum. The magnification of this image is x400.
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The result was positive, indicating Epstein-Barr virus (EBV) infection (Fig. 5).
The patient's clinical course.
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At the same time, the increased serum level of IgM had decreased to within the reference range (Fig. 6).