PMC3626553_01
(a,b) Ultrasound image of right thyroid lobe with the features of nodular remodeling in 57-year-old female with SLL-B/CLL-B.
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F1
Three focal lesions were found with the size of 9 x 5 mm, 8 x 5 mm and 12 x 11 mm (Figure 1).
(a,b) Ultrasound image of left thyroid lobe with the infiltration of small lymphocytic B-cell lymphoma in 57-year-old female with SLL-B/CLL-B.
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F2
The largest focal lesion found in the left lobe was 35 x 23 mm large, was poorly separated, being solid-liquid in nature, and had heterogeneous, hypoechogenic structure with calcifications (Figure 2).
(a,b) Ultrasound image of cervical lymph node packages located along the sternocleidomastoid muscle in 57-year-old female with SLL-B/CLL-B.
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F3
Multiple packages of deeply hypoechogenic lymph nodes without visualized vascular hila and with pathologic vascularization were seen along the sternocleidomastoid muscles in Power Doppler ultrasound (Figure 3).
Cytological smear composed of cells somewhat larger than small lymphocytes. The nuclei appear spherical, the chromatin is coarsely granular and nuclei have regular contour. The nucleoli are not prominent. Single hemosiderophages are visible. The smears were fixed in alcohol and stained with hematoxylin-eosin (x400).
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F4
Cytological picture of the lesion located in the left lobe suggested the infiltration of small lymphocytic lymphoma (Figure 4).
(a-d) Flow cytometry interpretation. The neoplastic cells display the typical antigenic features of CLL including small cell size and bright CD23 and CD5 expression. Some of the tumor cells have features of atypia and express CD8; these cells are considered to be more aggressive with azurophilic granules within cytoplasm. Yellow: CD3+/CD4-/CD8-; dark-blue: CD3+; red: CD23+/CD22 + dim; green: CD79b + dim.
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F5
It was concluded that atypical cells from the sampled material have B-CLL immunophenotype: CD19+/CD20+/CD22dim/FMC-7,CD23+/CD5+,sCD79b-+,CD38-,CD10-, kappa and lambda - weak reaction (Figure 5).