PMC7171631_01
Computed tomography scanning images. Whole circumferential thickening of the jejunum is shown (arrows) (a), (b).
CRIGM2020-7947540.001.jpg
PMC7171631_01_CRIGM2020-7947540.001.jpg
fig1
Computed tomography scanning showed whole circumferential thickening of the jejunum with aneurysmal dilatation, which is a typical feature of malignant lymphomas of the intestine (Figure 1).
Positron emission tomography scanning images. Tracer uptake is observed in the thickened intestinal wall.
CRIGM2020-7947540.002.jpg
PMC7171631_01_CRIGM2020-7947540.002.jpg
fig2
On positron emission tomography scanning, tracer uptake was observed in the thickened intestinal wall (Figure 2).
Double balloon enteroscopy images. A circumferential ulcer with necrotic debris in the jejunum is shown.
CRIGM2020-7947540.003.jpg
PMC7171631_01_CRIGM2020-7947540.003.jpg
fig3
Double balloon enteroscopy revealed circumferential ulcer and necrotic debris in the jejunum (Figure 3).
A contrast study image during enteroscopy. An irregularly dilated jejunal lumen is observed (arrows).
CRIGM2020-7947540.004.jpg
PMC7171631_01_CRIGM2020-7947540.004.jpg
fig4
A contrast study during enteroscopy showed dilated jejunal lumen (Figure 4).
Flow cytometry results. We performed flow cytometry using 2 endoscopically biopsied fragments. The kappa/lambda ratio of CD19+/CD20+ cells is 3.3 (53.36/16.39), indicating positive light chain restriction.
CRIGM2020-7947540.005.jpg
PMC7171631_01_CRIGM2020-7947540.005.jpg
fig5
Thus, we performed flow cytometry analysis with 2 endoscopically biopsied fragments, as described previously (Figure 5).
Pathological images. Infiltration of atypical, large lymphoid cells is seen in the endoscopic biopsy specimens (a): Hematoxylin-eosin stain. Lymphoma cells are positive for CD20 (b) and BCL2 (c), while they are negative for CD3 (d), CD5 (e), CD10 (f), and cMYC (g). The cells are diffusely positive for Ki-67 (h). The results of in situ hybridization for Epstein-Barr virus-encoded small RNA-1 (EBER) are also positive (i).
CRIGM2020-7947540.006.jpg
PMC7171631_01_CRIGM2020-7947540.006.jpg
fig6
Biopsy of the jejunal lesion showed infiltration of atypical, large lymphoid cells that were positive for CD20 and BCL2 and negative for CD3, CD5, CD10, and cMYC (Figure 6).