28296749 Visualization

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