PMC5313430_01
Inguinal lymphoid biopsy. (a) A low power view of an inguinal lymph node biopsy specimen [Hematoxylin and Eosin (H&E) staining, x25]. The normal lymph node architecture is almost completely effaced and the diffuse infiltration of lymphoid cells is observed. (b) A moderate-power view of the inguinal lymph node biopsy specimen (H&E staining, x100). The aggregation of medium-sized atypical lymphoid cells and marked vascular proliferation can be observed. The neoplastic lymphoid cells have a clear to pale cytoplasm and convoluted nuclei with dispersed chromatin. Immunohistochemical staining for (c) CD3 (x100), (d) CD10 (x100), (e) CXCL13 (x100), and (f) CD21 (x50) revealed that most of the neoplastic cells showed CD3 positivity; the cells were negative for CD10 expression but some expressed CXCL13. The CD21 immunohistochemistry highlights the expansion of follicular dendritic cells. (g) EBV EBERin situ hybridization (x100) showing the marked infiltration of EBV-positive B cells. CD: Cluster of differentiation, CXCL: C-X-C motif chemokine ligand, EBER: Epstein-Barr-virus-encoded small RNA, EBV: Epstein-Barr virus
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As shown in Fig. 1, the near-complete effacement of the normal lymph node architecture was observed; this was associated with marked vascular proliferation and aggregates of medium-sized atypical lymphoid cells in the inguinal lymph nodes.
Renal biopsy. (a) Light microscopy, focal infiltration by small to medium-sized atypical lymphoid cells can be seen in periglomerular and peritubular regions (Hematoxylin and Eosin staining, x40). (b and c) An immunofluorescence examination showing mesangial deposits of (b) IgA (x40) and (c) C3 (x40). (d) An electron microscopic image (x3,000) showing a small amount of dense deposits in the mesangial matrix. C3: complement component 3, IgA: immunoglobulin A
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Renal biopsy showed malignant lymphoma invasion and an IgA nephropathy pattern (Fig. 2).