--- a
+++ b/processing/MACCROBAT/28296749.txt
@@ -0,0 +1,14 @@
+A 64-year-old man was admitted to the Department of Gastroenterology of the Affiliated Hospital of Qingdao University Medical College (Qingdao, China) due to epigastric pains.
+Physical examination revealed no palpable mass, lymphadenopathy, or organomegaly.
+On endoscopy, several submucosal lesions were identified in the gastric antrum and the duodenal bulb (Fig.1).
+Endoscopic ultrasonography (EUS) (OLYMPUS EUS EU-ME2, Miniprobe sonography) demonstrated that the lesions were almost 0.5-cm homogeneously hypoechoic neoplasms originating from the submucous layer (Fig.2) and the initial diagnosis was digestive neuroendocrine tumors.
+Computed tomography revealed enlarged lymph nodes in multiple regions (mediastinal, retroperitoneal, mesenteric, and inguinal) and intracavitary nodules in the duodenum.
+To reach a definitive diagnosis, the patient underwent repeat EUS and biopsy was performed.
+On endoscopy, a 2 × 1-cm columnar uplift in the terminal ileum and multiple submucosal lesions in the rectum were identified (Fig.3).
+EUS revealed that the lesions in the terminal ileum were sized 1.6 × 1.2 cm and the lesions in the rectum were sized almost 0.6 × 1.0 cm, they were all homogeneously hypoechoic and originated from the muscularis mucosa layer.
+Pathological examination of the biopsied specimens from the lesions of the rectum showed diffuse lymphomatous proliferation and dense infiltration by monomorphic, small cleaved cells with irregularly shaped nuclei (Fig.4).
+On immunohistochemical analysis, the cells were positive for cyclin D1, CD20, CD21, SOX-11, and Bcl-2, but negative for CD3 and CD10, which was compatible with the diagnosis of MCL.
+Ki-67 staining revealed a proliferative index of 30%.
+Based on these findings, the diagnosis of Ann Arbor stage IV MCL was confirmed.
+The patient was referred for combination chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP regimen).
+The patient has been in remission clinically.