PMC7105335_01
Patient 1, bone marrow biopsy with AITL: (A) Focal, interstitial marrow involvement with monomorphic population of small to medium-sized lymphoid cells with moderately abundant pale eosinophilic cytoplasm, H&E, 100x. (B) PD-1, 100x. (C) EBER ISH, 400x.
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figure1
Her bone marrow biopsy found atypical lymphoid aggregates that contained a mixed population of T-cells positive for CD3, CD5 and PD1, and B-cells positive for CD20 and variably positive for PAX-5 and BCL6 (Figure 1; Table 1).
Patient 1, axillary lymph node with AITL: (A) Prominent vascular proliferation of high endothelial venules (HEVs) and nodal architecture effacement by a monomorphic lymphoid population, H&E, 100x. (B) Neoplastic population of follicular helper T cells with small to medium-sized nuclei and clear-to-pale cytoplasm, especially clustering adjacent to HEVs, and scattered CD30+ immunoblasts (circled, IHC not shown). H&E, 400x. (C) Increased numbers of T cells in effaced areas, especially perivascular T cells, CD3, 100x. (D) Increased numbers of neoplastic follicular helper T cells, PD-1, 100x. (E) Expanded dendritic meshwork, CD21, 100x. (F) EBER in situ hybridisation (EBER ISH) positive neoplastic T cells, 100x.
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figure2
Excisional axillary lymph node biopsy had immunostaining positive for CD2, CD3, CD5, CD7 and CD4 PD-1, and negative for CD30 in the lesional T-cells, consistent with AITL (Figure 2; Table 1).
PMC7105335_02
Patient 2, axillary lymph node with AITL: (A) Partial nodal architecture effacement by a monomorphic lymphoid population and increased numbers of eosinophils, H&E, 100x. (B) Neoplastic population of monomorphic follicular helper T cells with small to medium-sized nuclei and clear-to-pale cytoplasm in a polymorphous background of neutrophils and increased numbers of eosinophils with scattered CD30+ immunoblasts (circled, IHC not shown), H&E, 400x. (C) Increased numbers of neoplastic helper T cells, CD4, 100x. (D) Increased numbers of neoplastic follicular T helper cells (dim) with scattered neutrophils (strong), CD10, 100x. (E) Increased numbers of neoplastic helper T cells, PD-1, 100x. (F) Expanded dendritic meshwork, CD23, 100x.
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figure3
His axillary lymph node biopsy with immunostaining was positive for CD2, CD3, CD4, CD5, CD7, CD10 (subsets), BCL-6 and PD-1 in the lesional T-cells, consistent with AITL (Figure 3; Table 1).
PMC7105335_03
Patient 3, cervical lymph node with T-ALL. (A) Relatively monomorphic infiltrate of neoplastic lymphocytes with irregularly shaped, hyperchromatic, small to medium-sized nuclei with inconspicuous nucleoli, 400x. (B) CD34-negative, (CD34-positive blood vessels as internal control), 100x. (C) CD10-negative, 100x. (D) TdT-positive (nuclear), 100x. (E) CD1a-positive, 100x. (F) Ki-67 with 80% proliferation index, 100x.
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figure4
His excisional cervical lymph node biopsy immunophenotype stained positive for Tdt, CD1a, CD2, CD7, cytoplasmic CD3, CD33 and CD34, and was negative for surface CD3 and MPO in the lesional T-cells, compatible with the diagnosis of T-ALL (Figure 4; Table 1).