PMC5216151_01
Macroscopic findings of gingival mass and gluteal skin eruptions.
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May 2014, at 41 years of age, he complained of abdominal pain with fever, which was found to be due to cholecystitis. Multiple pulmonary nodule shadows, hepatosplenomegaly, and a gingival mass were noted (Figure 1, 2). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the gingival mass, the systemic eruptions, and the gluteal muscle (Fig. 3).
Computed tomography shows multiple pulmonary nodule shadows in whole lung fields.
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May 2014, at 41 years of age, he complained of abdominal pain with fever, which was found to be due to cholecystitis. Multiple pulmonary nodule shadows, hepatosplenomegaly, and a gingival mass were noted (Figure 1, 2). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the gingival mass, the systemic eruptions, and the gluteal muscle (Fig. 3).
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) shows FDG accumulation in the gingival mass, the systemic eruptions, and the gluteal muscle. Multiple pulmonary nodules show poor FDG avidity on FDG-PET image.
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May 2014, at 41 years of age, he complained of abdominal pain with fever, which was found to be due to cholecystitis. Multiple pulmonary nodule shadows, hepatosplenomegaly, and a gingival mass were noted (Figure 1, 2). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the gingival mass, the systemic eruptions, and the gluteal muscle (Fig. 3).
Histological study of gingival mass (original magnification, x200): Atypical lymphocytes diffusely invade to muscular layer.
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EBV-encoded small RNA in situ hybridization (EBER-ISH) was positive in atypical lymphocytes (Figure 4, 5).
Immunohistochemical studies and EBER-ISH of gingival mass: CD30+, granzyme B+, ALK-, and EBER-ISH+.
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EBV-encoded small RNA in situ hybridization (EBER-ISH) was positive in atypical lymphocytes (Figure 4, 5).
EBV southern blot analysis (A: whole blood, B: gingival mass). M: size marker, 1: positive control, 2: negative control, 3: patient specimen. Monoclonal proliferation of EBV-infected cells was demonstrated in peripheral blood and in gingival mass tissue by Southern blot analysis.
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Monoclonal proliferation of EBV-infected cells was demonstrated in the peripheral blood and in the oral mass tissue via a Southern blot analysis (Fig. 6).
Clinical course. EPOCH: etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, Capizzi: high-dose cytarabine, L-asparaginase, CBT: cord blood transplantation, ALT: alanine aminotransferase, MMF: mycophenolate mofetil, TAC: tacrolimus
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A histopathological examination of the skin eruptions revealed the invasion of EBER-ISH-positive T cells, and the withdrawal of tacrolimus successfully induced complete remission again (Fig. 7).