The cross-sectional anatomy and the needle trajectory of ultrasound-guided intradiscal injection using C6/7 level as an illustration. . Abbreviations: AS, anterior scalene; C7R, C7 root; CA, carotid artery; Eso, esophagus; LCo, longus colli; Omo, omohyoid; SCM, sternocleidomastoid muscle; ST, superior trunk of brachial plexus; Tra, trachea; Thy, thyroid.


The anteroposterior fluoroscopy view validating the needle placement and contrast spread during the injection of C5/6 intervertebral disc.


Immunohistochemical stain for CD30 shows diffuse strong immunoreactivity on the cell membrane and in the Golgi region (original magnification x200).


Immunohistochemical stain for CD45 (LCA) shows diffuse membranous staining (original magnification x200).


Immunohistochemical stain for CD4 shows diffuse membranous staining of tumor cells (original magnification x200).


EEG background presented with diffuse delta slowing, but without hemispheric asymmetry nor epileptiform discharges. The impression picture was in favor of severe encephalopathy.


Patient's three-generation pedigree.


Image of patient exhibiting edematous erythema, ulcer, and necrosis over the right nasal alae and upper lip.


Microscope image of biopsied lesion tissue showing numerous hyaline and septate hyphae with branches at acute angles scattered in the dermis (arrowhead) (periodic acid-Schiff, original magnification x 400).


Blood cell counts during hospitalization.


Computed tomography of the abdomen and pelvis with intravenous contrast displaying gastric antral wall thickening (arrows), diffuse omental infiltration, and linitis plastica.


Computed tomography enterography showing jejunal inflammation with edema.


Case report timeline. DIIHA, drug-induced immune hemolytic anemia; WRBCs, washed red blood cells; LRBCs, leukocyte-reduced red blood cells. +, strong; +-, slightly strong. Red blood cells lifespan: the average survival time of red blood cells measured by using the open-breath CO breath test.


Histopathological images of the brain. A; Macroscopic view of the specimen. Tumors are confirmed as red color lesion.


Histopathological images of the brain. B; Lymphoma cell invasion is confirmed inside the vessel of the vein (red arrow). Hematoxylin and eosin staining (x200).


Histopathological images of the brain. C; The immunohistochemical study of lymphoma cell is positive for CD20 (x200).


Clinical photographs of patient's face. Note the distinctive facial features with bushy arched eyebrows, long eyelashes, thick everted upper lip, broad nasal bridge, facial nevi, and hypertrichosis on upper cutaneous lip.


Clinical photograph of patient's knees, with numerous depigmented demarcated patches in a semisymmetrical distribution.


Clinical photograph of patient's trunk, with numerous scattered melanocytic nevi.


Computed tomography (CT) image of the upper abdomen demonstrates multiple splenic lacerations evidenced by the irregular, nonhomogeneous, low density of splenic body (red arrows).


CAMT: Areas of ganglioneuroma (thick arrow) are seen admixed with areas of pheochromocytoma (thin arrow) (original magnification x20).


Ganglioneuroma component of CAMT with many ganglion cells intricately associated with spindle schwannian stroma (original magnification x40).


Pheochromocytoma component of CAMT with polygonal cells arranged in cords and trabeculae within loose Schwannian matrix (original magnification x20).


Immunostaining with chromogranin highlights the pheochromocytoma element of CAMT (original magnification x10.


Endoscopic picture of the second part of the duodenum showing a nodular mass with superficial erosion and active bleeding.


Endoscopic picture of the second part of the duodenum showing small nodules with focal erosion.


Normal endoscopic picture of the second part of the duodenum.


Glomerulus showing a cellular crescent with fibrinoid necrosis (Jones methenamine silver stain x 200).


Obsolescent glomerulus with adjacent multinucleated giant cell (H & E x 200).


Bright linear IgG staining of the glomerular capillary loops on immunofluorescence.


Necrotizing arteritis with transmural inflammation in the lung instertitium (H & E x 200).


Multinucleated giant cells in the lung (H & E x 400).


A mass emanating from the supraglottic part of larynx without erosion or haemorrhage and a lesion of the true right vocal cold presenting as leukoplakia.


Low-power view of the mass shows two neoplastic populations (sarcomatoid and epithelial component) and the overlying dysplastic epithelium (H&E, X40).


(A) Low-power view demonstrates the neoplastic populations to intermingle (H&E, X100).


(B) Low-power view shows the sarcomatoid component and the overlying epithelium (H&E, X100).


Diffuse immunoreactivity of squamous cell carcinoma and the overlying epithelium for cytokeratin AE1/AE3 and focal/weak immunoreactivity of the sarcomatoid component (Immunoperoxidase with haematoxylin counterstain, X100).


Small supraglottic mass just above the anterior commissure two months after initial treatment was excised with CO2 laser and proved to be a recurrence of histiocytoma. The patient remained disease-free nine months after the second look cordectomy.


(A) In chest X-ray, permeability was reduced in bilateral lower lung field and butterfly shadow was observed. Cardio-thoracic ratio (CTR) was 59.8% and both costophrenic angles (CPA) were blunt.


(B) Abdominal contrast-enhanced computed tomography revealed a 50-mm hyper-vascularized tumor with calcification in the right adrenal gland and multiple hyper-vascularized tumors in the liver. The right adrenal gland showed round shape and a mixture of high- and low-density area. In addition, since there was thin adipose tissue between the right adrenal gland and the kidney and inferior vena cava, there seemed to be no infiltration into surrounding organs.


(C) In 131I MIBG scintigraphy, there was high accumulation in the right adrenal gland and multiple accumulation in the liver, and there was small hot spot in the sternum and right rib.


Image of bone marrow aspiration (400x) showing hypercellularity with elevated level of myeloblasts, eosinophils, and basophils.


(a) Computerized tomography scan showing hypodense area in right frontal -temporal region with areas of the infarct (arrow).


(b) Peripheral smear showing microcytic hypochromic red blood cells with increased white blood cell (WBC) count and decreased platelet (Leishman, xobj.


40). (c and d) Peripheral smear showing increased WBC with blasts (arrow head). Note the presence of basophil (arrow) (Leishman, xobj. 100).


Interictal electroencephalogram was found with spikes and sharp waves over the bilateral frontal region, anterior midline region and centrotemporal region during both the waking.


Sleeping. Periods.


MRI showed lacunar infarction in the left basal ganglia with glial proliferation around in T1-flair.


T2-fse imaging.


MRV showed small tiny left transverse sinus, sigmoid sinus, and internal jugular vein.


Hemoglobin level as a function of time and treatments. Doses of oral steroids are specified below the respective arrows. Intravenous cyclosporin was introduced at 3 mg/kg for 3 days before being switched for oral cyclosporin 80 mg twice a day with a slow taper.


Endoscopic findings: colonoscopy revealing large tumor-like protruding mass near the cecum.


Pathological images from biopsy specimen. . A. H&E staining of biopsy specimen. (x100).


Pathological images from biopsy specimen. . B. Cyclin D1 expression in majority of nuclei. (x100).


Computed tomography, portal venous phase: tumor of about 5cm in diameter filling out the right pyelon and showing slow contrast enhancement.


A; Typical fascicles of mitotically active spindle-shaped cells of monophasic synovial sarcoma.


B; Tumor cells invading into a blood vessel lumen.


FISH-testing revealing SYT gene rearrangement: some cells show a normal signal with yellow fusion signals (orange arrow), reflecting nonrearranged alleles. The majority of cells, however, show a pathological signal pattern with separated orange and green signals (green arrows) indicative of a rearrangement.


Coronal CT scan taken two years ago shows massively enlarged kidneys filled with numerous cysts and occupying the abdominal and pelvic cavities. Note that there are only a few cysts in the liver.


Clinical course showing dry body weight, predialysis blood urea nitrogen (BUN) and hemoglobin (Hb) levels. HD, hemodialysis; EPO, erythropoietin.


Chest X-ray of the infant at presentation, showing a large intrathoracic radiopaque mass occupying the right hemithorax.


Chest CT scan showing the large mediastinal mass.


T2-weighted ,. On the sagittal T2-weighted and T1-weighted images (A and B, respectively), notice the homogenous reduction of signal intensity of the T2 vertebral body (arrow) relative to all other vertebrae.


T1-weighted ,. On the sagittal T2-weighted and T1-weighted images (A and B, respectively), notice the homogenous reduction of signal intensity of the T2 vertebral body (arrow) relative to all other vertebrae.


Short tau inversion recovery (STIR). There was no abnormal hyperintense signal observed within the vertebral body on the STIR sagittal image (C).


T2-weighted ,. At the level of mid-body of the T2 vertebra, there was a symmetric, ventrally located, extradural lesion causing secondary spinal cord compression (asterisk, D-F). The lesion was isointense relative to spinal cord parenchyma on T2-weighted ,hyperintense on T1-weighted non-contrast images, and ,T1-weighted contrast.


T1-weighted ,. At the level of mid-body of the T2 vertebra, there was a symmetric, ventrally located, extradural lesion causing secondary spinal cord compression (asterisk, D-F). Fat saturation images. Respectively).


T1-weighted contrast fat saturation. Cervicothoracic images of a 9-year-old cat. At the level of mid-body of the T2 vertebra, there was a symmetric, ventrally located, extradural lesion causing secondary spinal cord compression (asterisk, D-F). Fat saturation images. Respectively).


Fine needle aspirate of cutaneous tail base mass. The discrete cells are small to medium in size and round to slightly ovoid in shape. They generally contain a single round nucleus eccentrically set in a small abundant amount of dark blue cytoplasm that occasionally contains a few pink granules. The nuclei exhibit a coarsely granular chromatin pattern. Moderate anisocytosis is noted. Hematoxylin and eosin; x60 magnification; bar = 20 mum.


Overview of haematopoietic bone marrow with a central granuloma. The arrows mark multinucleated giant cells. The inset shows a granuloma with the typical radially arranged fibres in the reticulin fibre stain.


Swelling over the left side neck on extraoral view.


Swelling in the left side retromolar region on intraoral view.


Occlusal radiograph of the left side mandible showing soap bubble appearance.


An expansile lytic multicystic lesion of size 5.5 cm x 3.0 cm x 2.7 cm with well-demarcated margin in the body of the left hemimandible on noncontrast computed tomography.


Three-dimensional computed tomography scan. Of the face and neck.


Multicystic appearance of the lesion on intraoperative finding.


Operative findings. (a) Fenestration through the posterior wall of the pontine cyst. The lower retractor was placed over the left cerebellum. The upper retractor was placed over the right cerebellum. Rostral cerebellum was toward the left of the image, and caudal cerebellum was toward the right of the image. Suction cannula in each of the panels is identified by a white arrow.


Operative findings. (b) Encountering a transparent greenish fluid collection upon cyst fenestration (black arrow).


Operative findings. (c) Visualizing the anterior wall of the pontine cyst.


Operative findings. (d) Mural nodule of the cyst visualized and biopsied (blue arrow).


Schematic of ventriculo-cysto-peritoneal shunting. The cyst catheter is T'ed into a right occipital peritoneal shunt at a site distal to the valve.


Illustration of the neutrophil count since cancer surgery was performed.


The Inhibitor Assay of Patient During Treatment.


Bone marrow stained for lambda (x 1000).


Low power biopsy ganglia (x 10).


Infiltration by plasma cells (x 400).


Plasma cells CD38 (+) (x 10).


Plasma cells CD19 (+) (x 10).


Kappa expression (x 400).


Lambda expression (x 600).


Bone marrow biopsy stained for kappa (x 400).


Mammographic images of a primary follicular lymphoma. Mammography shows a round, high-density mass.


Microscopic findings of a primary follicular lymphoma. (A) Note the proliferation of atypical lymphoid cells with a follicular growth pattern (H&E staining, x40).


Microscopic findings of a primary follicular lymphoma. The specimen is immunoreactive for CD20. X40).


Microscopic findings of a primary follicular lymphoma. Bcl-6. X12.5).


Microscopic findings of a primary follicular lymphoma. Negative for CD3. X12.5).


Contrast abdominal CT showed the pancreatic head [(A), red arrow] with the absence of the pancreatic body and tail.


Renal cortical cysts on bilateral kidneys were pointed out with blue arrows (B).


The gene sequencing showed a heterozygous mutation of HNF1B gene in exon 2 (c.513G>A) of the patient.


His father.


The sequencing of his mother was wild-type (E).


Schematic presentation of therapies administered and changes in key clinical indices during the 119 days of hospitalization. mPSL = Methylprednisolone; PSL = prednisolone; PE = plasma exchange; HD = hemodialysis; Plt = platelets; LDH = lactate dehydrogenase; BP = blood pressure.


Renal biopsy specimens examined on hospital day 22 using light microscopy. A; Hematoxylin and eosin staining. Original magnification x20.


Renal biopsy specimens examined on hospital day 22 using light microscopy. B; Periodic acid methenamine silver staining. Original magnification x40.


Renal biopsy specimens examined on hospital day 22 using light microscopy. C; Metallothionein staining. Original magnification x20.


Renal biopsy specimens examined on hospital day 22 using light microscopy. D; Electron microscopy. All 17 glomeruli examined under light microscopy show a loss of normal architecture. Renal arterioles, including afferent and efferent arterioles, show endothelial cell edema and proliferative changes, and atrophy of renal tubules. Electron microscopy demonstrates extensive, dense extracellular fibril deposits (arrow).


Preoperative picture showing right temporal swelling.


Decreased mouth opening.


CT scan of lesion.


CT scan of secondary lesion showing
involvement of condylar head.


CT scan of secondary lesion in right temporal
region showing bony cystic lesion.


PA view showing stump of posterior
border of ramus.


Intraoperative view.


Enmass enucleation of cystic lesion.


Excise lesion and zygomatic arch.


Closure of operative area.


Postoperative improved mouth opening.


Postoperative view showing complete healing.


(a) The forehead of the patient, showing papulonodular and plaque lesions.


(b) The scalp of the patient, showing scaly plaques and papulonodular lesions.


(c) The front view of the patient, showing multiple papulonodular lesions and plaques.


(d) The back view of the patient, showing papulonodular lesions, plaques, and some ulceration.


(a) A photomicrograph showing a dense diffuse lymphocytic infiltrate in the upper and mid dermis with no particular adnexotropism. The inset reveals these atypical lymphocytes mainly arranged in an interstitial pattern (H & E: 100x and 400x).


(b) A photomicrograph showing lymphocytic infiltrate weakly positive for T-cell marker CD8 (IHC: 400x).


(c) A photomicrograph showing lymphocytic infiltrate strongly positive for T-cell marker CD4 (IHC: 400x).


(d) A photomicrograph showing negative expression of B-cell marker CD20 (IHC: 400x).


Change in serum creatinine level of the patient during her hospital stay.


Change in platelet count of the patient during the first 35 days of hospital stay (TPE - therapeutic plasma exchange).


Change in red cell count and hemoglobin during the first 35 days of hospital stay (TPE - therapeutic plasma exchange).


Clinical pictures from oropharyngoscopy and laryngoscopy from the third relapse. (A) Before treatment. The oral cavity and oropharyngeal isthmus show swelling, papilloma-like lesions, and eroded uvula.


Clinical pictures from oropharyngoscopy and laryngoscopy from the third relapse. (B) Before treatment. Swelling of the epiglottis vestibular folds and aryepiglottic folds are seen.


Clinical pictures from oropharyngoscopy and laryngoscopy from the third relapse. (C) One month after treatment. Near-normal findings.


Reduction in cell surface levels of CD40L in CD4pos T cells from the index patient compared with a control individual. (A) CD40L expression after PMA/ionomycin stimulation (light red/light green) on CD4pos T-cells and on unstimulated (dark red/dark green) CD4pos T-cells from the index patient (red colors) compared with healthy control (green colors).


Reduction in cell surface levels of CD40L in CD4pos T cells from the index patient compared with a control individual. (B) Control of PMA/ionomycin stimulation monitored by CD69 upregulation on CD4pos T cells in the patient (light red) and a healthy control (light green). PE, phycoerythrin; PerCP, peridinin chlorophyll protein complex.


Computed tomography (CT) thorax showing the sternoclavicular mass as indicated by the two arrows.


X-ray of the left elbow joint shows osteomyelitis and destruction of the joint as indicated by the arrow.


(a) Juxtapapillary retinal hemangioblastoma with adjacent lipid exudation.


Note minimal lipid exudation in the papillomacular bundle region.


Foveal contour is normal before photodynamic theraphy (PDT). OCT performed 1 day after PDT shows retinal edema.


Subretinal fluid under the foveola. Three weeks after PDT there is complete reabsorption of intraretinal and subretinal fluid. There are a few focal intraretinal optically dense juxtafoveal deposits consistent with ophthalmoscopically visible lipid exudates.


Partially pigmented retinal astrocytoma (needle biopsy proven) with lipid exudation at the superior, inferior, and ,nasal margins extending into the fovea.


Forming a foveal star.


OCT before PDT reveals moderate intraretinal cystoid edema at the fovea.


Three days after PDT there is increased subretinal fluid. Four months later, there is complete reabsorption of intraretinal and subretinal fluid leaving retinal atrophy.


Medical image.


Color fundus photograph showing small amelanotic choroidal melanoma with documented growth.


OCT shows normal fovea before PDT. Eleven days after PDT.


Neurosensory retinal detachment extending under the fovea is evident. Three months after PDT, subretinal fluid has completely disappeared and foveal contour has returned to normal.


Mucicarmine staining of BAL fluid cytology (, x400) show intracellular yeasts, engulfed by macrophages (arrow in ), and extracellular yeasts with thick capsule (arrowhead in.


Histopathologic sections of the left lower lobe and right upper lobe biopsies reveal non-necrotizing granulomatous inflammation (, H&E stain, 400x).


Organizing pneumonia (, H&E stain, 400x), respectively.


The follow-up chest radiography obtained after six months of antifungal therapy showing a marked decrease in the size of alveolar opacity at the right upper lung and left lower lung, including left pleural effusion.


Peripheral blood smear showing plasma cells with eccentric nucleus, perinuclear halo with basophilic cytoplasm.


Bone marrow trephine biopsy shows nodular aggregate of neoplastic plasma cells. H&E, x400.


DNA sequencing (with white blood cells) showed a germline MET exon 14 skipping mutation.


Pathologic findings of the primary tumor and the pulmonary lesion specimen after trastuzumab-based therapy. (A) Hematoxylin and eosin staining of the primary tumor revealed bladder adenocarcinoma (magnification x200).


Pathologic findings of the primary tumor and the pulmonary lesion specimen after trastuzumab-based therapy. (B) Hematoxylin and eosin staining of the pulmonary lesion specimen after trastuzumab-based therapy revealed adenocarcinoma, indicating that it was a metastasis of bladder adenocarcinoma (magnification x200).


Pathologic findings of the primary tumor and the pulmonary lesion specimen after trastuzumab-based therapy. (C) The primary tumor exhibited strong positive immunohistochemical staining for HER2 (3+) (magnification x200).


Pathologic findings of the primary tumor and the pulmonary lesion specimen after trastuzumab-based therapy. (D) The pulmonary lesion specimen after trastuzumab-based therapy exhibited positive immunohistochemical staining for HER2 (2+) (magnification x200).


Analysis results from the STRING website. (A) Relationship of seven mutant genes before trastuzumab-based therapy.


Analysis results from the STRING website. (B) Relationship of five mutant genes after trastuzumab-based therapy.


MRI scan. (a) Multiple enhancing corpus callosum lesions.


MRI scan. (b, arrow) Partial open-ring pattern in the left occipital lobe and right periventricular lesion.


MRI scan. (c, arrow) High signal on diffusion-weighted imaging.


MRI scan. (d, arrow) Low values on ADC map.


MRI scan. (e) Spontaneous regression five days after biopsy.


Axial brain CT scans showing the hypodense mass with partially calcified rim and bone erosion of the adjacent left temporal bone. (a,b) Axial T2-weighted MR image showing hyperintense lesion at the left temporal bone.


Axial brain CT scans showing the hypodense mass with partially calcified rim and bone erosion of the adjacent left temporal bone. (c) Axial T1-weighted MR image showing hypointense circumferential mass and hyperintense fluid component in the mass.


Axial brain CT scans showing the hypodense mass with partially calcified rim and bone erosion of the adjacent left temporal bone. (d) Axial and coronal enhanced T1-weighted MR images showing heterogeneous contrast enhancement of the tumor.


Axial brain CT scans showing the hypodense mass with partially calcified rim and bone erosion of the adjacent left temporal bone. (e,f).


Intraoperative photos after the left frontotemporal skin flap was raised, illustrating the yellowish gelatinous tumor and the involved temporal bone. (a) After removal of the outer table.


Intraoperative photos after the left frontotemporal skin flap was raised, illustrating the yellowish gelatinous tumor and the involved temporal bone. (b) Removal of the tumor and the inner table.


Intraoperative photos after the left frontotemporal skin flap was raised, illustrating the yellowish gelatinous tumor and the involved temporal bone. (c) The gross pathological specimen.


Intraoperative photos after the left frontotemporal skin flap was raised, illustrating the yellowish gelatinous tumor and the involved temporal bone. (d).


Postoperative brain CT scans showing removal of the tumor and reconstruction with titanium mesh plate. (a,b) Axial T2-weighted MR image showing decompression of the left temporal lobe.


Postoperative brain CT scans showing removal of the tumor and reconstruction with titanium mesh plate.


Postoperative brain CT scans showing removal of the tumor and reconstruction with titanium mesh plate. T1.


Postoperative brain CT scans showing removal of the tumor and reconstruction with titanium mesh plate. Enhanced T1-weighted. MR images showing total removal of the tumor.


Macroscopic view showing a proliferation of bland spindle cells with myxoid stroma. (a) Microscopic view showing spindle cells having ovoid to elongated and atypical hyperchromic nuclei with prominent macrophages and no cartilage, osteoid, or bone.


Macroscopic view showing a proliferation of bland spindle cells with myxoid stroma. (b).


26-year-old male patient presented with fever, night sweat and shortness of breath, subsequently diagnosed to have pericardial effusion leading to cardiac tamponade. Further studies led to the diagnosis of Hodgkin lymphoma. Chest X-ray posteroanterior view shows mediastinal widening (arrow) suggestive of mediastinal lymphadenopathy.


26-six-year-old male patient presented with fever, night sweat and shortness of breath, subsequently diagnosed to have pericardial effusion leading to cardiac tamponade. Further studies led to the diagnosis of Hodgkin lymphoma. Cervical lymph node biopsy stained with hematoxylin and eosin magnification x10 shows lacunar variety of Reed Sternberg cell (arrow) suggestive of nodular sclerosing Hodgkin lymphoma.


26-six-year-old male patient presented with fever, night sweat and shortness of breath, subsequently diagnosed to have pericardial effusion leading to cardiac tamponade. Further studies led to the diagnosis of Hodgkin lymphoma. Computed tomography scan thorax of the same patient shows anterior mediastinal lymphadenopathy (arrow) greatest dimension of the mass is 14.8 cm.


26-year-old male patient presented with fever, night sweat and shortness of breath, subsequently diagnosed to have pericardial effusion leading to cardiac tamponade. Further studies led to the diagnosis of Hodgkin lymphoma. Computed tomography scan thorax shows pericardial effusion (arrow).


(A) Electrocardiogram on admission showing ST-segment elevation in the precordial leads.


(B) Electrocardiogram after percutaneous coronary intervention showing significantly improved ST-segment elevation resolution.


(A) Coronary angiogram revealing patent right coronary artery (RCA).


(B) Coronary angiogram revealing minimal stenosis of <30% near proximal left anterior descending coronary artery (LAD) and occlusive thrombus in distal LAD.


(C) Recovery of antegrade flow into distal LAD after manual thrombus aspiration.


(D) Index echocardiogram revealing left ventricular (LV) apical thrombus.


(E) Computed tomography scan revealing right adrenal mass which is of soft tissue attenuation with heterogeneous contrast enhancement.


(F) Echocardiogram performed at the 2-month follow-up revealing left ventricular (LV) apical aneurysm.


Eye.


Stripes and ridges.


MRI of orbital tumor.


Epidural soft tissue mass located in the spinal canal outside the back of the dura mater at T4-T9 level, dura mater and spinal cord significantly compressed forward, and the narrowed spinal canal. T1WI at the position of sagittalia, low signal.


Epidural soft tissue mass located in the spinal canal outside the back of the dura mater at T4-T9 level, dura mater and spinal cord significantly compressed forward, and the narrowed spinal canal. Sagittal postcontrast T1-weighted image of the thoracic spine reveals enhancing sheet-like lesion in the posterior epidural region compressing the thoracic cord.


Epidural soft tissue mass located in the spinal canal outside the back of the dura mater at T4-T9 level, dura mater and spinal cord significantly compressed forward, and the narrowed spinal canal. Shown by red arrow mark,. T2WI at the position of sagittalia, high signal.


Epidural soft tissue mass located in the spinal canal outside the back of the dura mater at T4-T9 level, dura mater and spinal cord significantly compressed forward, and the narrowed spinal canal. T2WI at coronal section, high signal.


Epidural soft tissue mass located in the spinal canal outside the back of the dura mater at T4-T9 level, dura mater and spinal cord significantly compressed forward, and the narrowed spinal canal. T1WI contrast enhancing at transverse section, high signal at T7 level obviously enhanced.


Epidural soft tissue mass located in the spinal canal outside the back of the dura mater at T4-T9 level, dura mater and spinal cord significantly compressed forward, and the narrowed spinal canal. T2WI at transverse section, high signal at T7 level. No abnormal changes were observed in the intervertebral disc.


Sagittal reconstructed CT scan image showing bladder mass.


MIBG scintigraphy:sagittal view showing bladder mass. MIBG, metaiodobenzylguanidine scan.


Laparoscopic view to start resection over guidance of cystoscopy light.


Histopathology slide of the lesion confirming the diagnosis of bladder paraganglioma.


Immunohistochemistry shows positivity for leukocyte common antigen.


Immunohistochemistry shows positivity for CD117.


Immunohistochemistry shows positivity for BCL2.


Ki67 index is about 60% of neoplastic cells (x400).


Magnetic resonance imaging revealed lesions consistent with infection in the left maxillar and ethmoid sinuses and left periorbital abcess formation.


Chest radiograph showing multiple, round, variably sized masses scattering in both lungs, compatible with pulmonary metastasis.


(a) Axial MIP image showing multiple masses, scattering in both lungs and surrounding segmental/subsegmental branches of pulmonary arteries, and multiple PAPs.


(b) Coronal 3D Volume Rendered image showing multiple PAPs scattering in both lungs. The two largest ones are located in both lower lobes.


Medical image.


Serial axial chest CT within one month showing aneurysmal dilatation and developing soft tissue masses surrounding the previously seen tumor emboli in the peripheral branches of right pulmonary arteries (arrows).


Serial axial chest CT at eight months prior.


One month prior.


The present study.


Showing gradual dilatation of peripheral branches of right pulmonary arteries, and finally pseudoaneurysms with surrounding soft tissue masses (arrows).


(A-C) Results of preoperative MRI. Round long T1 and long T2 signal intensities existed in the left cerebellar hemisphere. Iso-T1 and T2 signal intensities of septa were found inside. Enhanced scanning showed annular enhancement in solid portion and no enhancement in cystic portion of the mass. The fourth ventricle was compressed rightward, and became narrow.


(D-F) Results of postoperative MRI. The patchy slight enhancement of the left cerebellar hemisphere was in line with the postoperative changes in tumor resection.


(G) (200x): HE staining to tumor showed disorderly arrangement of cells.


(H,I) (400x): Positive expression of CD 31 and CD 34 detected using immunohistochemistry.


(A-D) Results of preoperative MRI. Patchy long T1 and long T2 signal intensities existed in the bilateral cerebellar hemispheres and vermis. Solid/cystic confounding signal intensities were observed in the enhanced lesion of right cerebellar hemisphere. The solid portion showed iso-T1 and T2 signal intensities, while cystic portion was long T1 and long T2 signal intensities. Enhanced scanning showed remarkable enhancement in solid portion and no enhancement in cystic portion of the mass. The brain stem was compressed, and the fourth ventricle became narrow. The supratentorial ventricle system expanded, with the tonsillar hernia intruded into the spinal canal. The central canal of the cervical cord expanded and strip-shaped long T1 and long T2 signal intensities was found at the level of C2-C6.


(E-H): Results of postoperative MRI. The initial lesion signals reduced. The solid/cystic lesions in the right cerebellar hemisphere and punctate enhancement lesions in the left cerebellar hemisphere were not shown clearly. The fourth ventricle enlarged. The cerebellar tonsillar did not develop into the spinal canal. A strip-shaped long T1 signal intensity still existed in the cervical cord.


(I) (200x):HE staining to tumor showed disorderly arrangement of cells.


(J,K) (400x): Positive expression of CD 31 and CD 34 detected using immunohistochemistry.


Patients' family pedigree for RNF139. Family numbers and disease-causing variant is noted above pedigree. Normal individuals are shown as clear circles (females) and squares (males). The patient above the arrow indicates the proband (IV.1).


(A) Results of NGS (RNF139 p. Q650R).


(B) Results of Sanger sequencing. The sequencing results in IV.1 and III.4 is RNF139 mutant homozygous type, while in III.2, III.3, and III.5 is wild type. The yellow region indicates the duplication at the nucleotide position for RNF139 gene NM_007218.


Immunohistochemical staining showing. LCA reactivity.


S100 reactivity.


CD1a reactivity in the large cells.


(d) IHC staining for EMA is negative in these cells.


Results of molecular cytogenetic analysis. Multicolor FISH. Showing trisomies of chromosomes X, 4, 14, 17 and 21.


Results of molecular cytogenetic analysis. And array CGH. Showing trisomies of chromosomes X, 4, 14, 17 and 21. And submicroscopic aberrations: deletion of chromosome 20 and amplification of chromosome 22.


Results of molecular cytogenetic analysis. BCR/ABL1 positive metaphase hybridized with BCR/ABL dual fusion (DF) probe demonstrating apparent loss of green 3'BCR signal, ie 1F2O1G FISH pattern (caused by the insertion of the ABL1 gene into the BCR region, thus entire BCR signal remained on chromosome 22) (C).


Results of molecular cytogenetic analysis. FISH with BAC probes RP11-80O7 (orange) and RP11-400P21 (green) with evidence of normal finding of 22q11.23 region matching to 3'BCR locus (two orange signals) and deletion of 20p12.1 (one green signal) (D).


Results of molecular cytogenetic analysis. Detailed view of array CGH result of chromosome 22 showing amplification of the 22q11.22 region and normal 22q11.23 region pattern (E).


HE staining of the specimen (x200).


Immunohistochemical examination revealed CD10.


Bcl-6 (+) suggested putative germinal center B-cell origin. . Abbreviation: HE, hematoxylin.


The breast lump with glistening of skin and venous prominence.


(a) Photomicrograph of cytology showing dispersed myeloid blast cells having small amount of granular basophilic cytoplasm, large round nuclei with prominent nucleoli in the case of myeloid sarcoma (Leishman and Giemsa stain, x40 view).


(b) Photomicrograph showing myeloperoxidase positive myeloblasts in the cytology smears (myeloperoxidase stain, x40 view).


Sagittal.


Coronal. Post-gadolinium brain magnetic resonance imaging showing intense dural enhancement of cerebral convexities and tentorium.


(E) Axial T2-weighted brain magnetic resonance imaging that shows abnormal signal changes within right cerebellar hemisphere.


(F) Post-contrast axial brain MRI shows abnormal parenchymal enhancement.


Erythematous maculopapular eruption affecting the torso.


BMB Hypercellular marrow, megakaryo-granulocytes proliferation, clustered polymorphous atypical megakaryocytes (HE stain, ob x20).


BMB Hypercellular marrow by diffuse plasma cells infiltrate; small clusters of giant megakaryocytes (HE stain, ob x40).


BMB Plasma cells infiltrate was clonal, with lambda light chain restriction (IHC stain for lambda light chain, ob 40x).


ARMS-PCR method for the detection of V617F mutation in JAK 2 gene low level positive for Case 2. 1st lane - Molecular weight marker (of 100 samples/ s in 100s); 2nd 9th lane - Pacient samples 2 lanes for each pacient; 10th - 11th lane - Positive control; 12th-13th lane - Negative control; 14th-15th - Blank. The first lane of each patient is mutant allele (JAK2 V617F) and the 2nd is the normal allele (wildtype JAK2).


2 BMB - Grade 2 fibrosis (Gomori stain, ob x20).


ARMS-PCR method used for detection of the V617F mutation in JAK 2 gene positive for Case 1. 1st lane - Molecular weight marker (of 100smp in 100 smp); 2nd 9th lanes - Pacient samples 2 locus for each pacient; 10th-11th lanes - Positive control; 12th-13th lanes - Negative control; 14th-15th lanes - Blank. The first lane of each patient is mutant allele (JAK2 V617F) and the 2nd is the normal allele (wildtype JAK2).


Aligned sequences showing mutation in JAK2 exon 14 - c1849 G>T (V617F). Prevalence of this mutation in this patient was 72%. Sequencing was performed on Miseq Illumina. For JAK2 exon 12, 13 and 14 sequencing, specific primers, which amplify exon 12, 13 and 14, were used. After amplification, amplicons were purified by using Agencourt Ampure XP magnetic beads following the manufacturer's protocol. Purified amplicons were indexed by using indexes provided by Illumina and resulting fragments sequenced on Miseq sequencer from Illumina, after another round of purification by using Agencourt Ampure XP. Sequencing was performed by using MIseq kit Nano and 2x250 sequencing protocol. Resulting sequences were aligned by using LaserGene 11.2 software and visualized and analyzed by using IGV version 2.3.40. An average coverage of 10000x was obtained for all exons.


Vertebral tumor - Extramedular infiltration of plasma cell myeloma (HE stain, ob 40x).


Serum protein electrophoresis, no monoclonal spike; normal values.


BMB IHC examinatin - interstitial lambda chain myelomatous infiltrate (IHC stain for lambda light chain, ob x20).


The mNGS and bone marrow result detected in Case 1. (A) The genome coverage of the detected reads of Leishmania shedunii.


The mNGS and bone marrow result detected in Case 1. (B) The abundance of detected microbe and their reads numbers. A total of 5074 specific reads (98.87%) of Leishmania were detected in the blood sample.


The mNGS and bone marrow result detected in Case 1. (C) The examination of a bone marrow aspirate revealed amastigotes.


The dose of liposomal amphotericin B (L-AmB) and changes of temperature in Case 1. The initial dosage of L-AmB in the first patient was 10mg/day and the patient's temperature decreased as the dose of L-AmB was escalated. Dose escalation was performed as follows: 10 mg on day 1, 30 mg on day 2, 80 mg on day 3, and 120 mg on day 4. However, the appearance of hypotension on day 4 of the treatment protocol forced the dose reduction on day 5 (80 mg/d). There was mild renal impairment on day 6. Therefore, treatment was interrupted on days 6-11, and his renal function gradually recovered during treatment cessation. Treatment was restarted at a dose of 10 mg/kg from day 12, and the dose was gradually increased at a rate of 10 mg/(kg day). The dose was increased to 40 mg on day 15. Since the patient's renal function was still slightly abnormal at day 15, the dose of L-AmB was not increased, but maintained at 40 mg during the next 12 days (day 16-27). Finally, we stopped the medication until the accumulating dose reached 890 mg(12.6 mg/kg) on the day 27. Polymerase chain reaction of Leishmania in a bone marrow smear was negative on day 17.


Liposomal amphotericin B (L-AmB) administration protocol and temperature changes in Cases 2-4. TAD, total accumulated dosage. Normalization of body temperature. Negative PCR result for bone marrow aspirate. To avoid complications associated with adverse drug reactions, the dosing regimens of L-AmB in case 2-4 were similar to those used for case 1, starting with a low dose that was gradually increased until the maximum tolerated dose was reached. This dosage was used for maintenance therapy. The initial dose for case 2 was 5 mg (~0.1 mg/kg) on day 1. The dose was increased to 10 mg on day 2-3, and no complications occurred. Therefore, the patient received L-AmB in 10 mg dose increments up to a dose of 60 mg (~1.2 mg/kg) on day 8. This dosage (60mg) was used for maintenance therapy until the cumulative dose of L-AmB reached 765 mg (13.9 mg/kg) on day 17. Her body temperature returned to normal on day 4. Polymerase chain reaction (PCR) for Leishmania in bone marrow aspirate was negative on day 12, when the dose of L-AmB was 405 mg. The trapezoidal regimen of L-AmB in case 3 was initiated at a dose of 5 mg (~0.1 mg/kg). The dosage of L-AmB was increased by 5 mg every 2 days as tolerated from day 1 to day 8 and increased by 10 mg every 2 days from day 9 to day 13 to 50 mg (~1.0 mg/kg), which was administrated as maintenance therapy on days 14-22. Treatment was stopped when the cumulative dose of L-AmB reached 740 mg(14.8 mg/kg) on day 22 of protocol. The patient's body temperature had returned to normal on day 4. PCR for Leishmania in bone marrow aspirate was negative on day 15, when the cumulative dose of L-AmB was 400 mg. In case 4, L-AmB treatment was initiated at a dose of 10 mg and increased in increments of 10 mg (~0.14 mg/kg) daily, reaching 70 mg (~1.0mg/kg) on day 7 of the protocol. To avoid complications, instead of further increasing the L-AmB dose, we used a dose of 70 mg as maintenance therapy until the cumulative dose reached 910 mg (13 mg/kg) on day 16. His body temperature returned to normal on day 7. PCR for Leishmania in bone marrow aspirate was negative on day 9, when the cumulative dose of L-AmB was 420 mg.


Graphical trend of M spike.


Graphical trend of kappa/lambda ratio.


Graphical trend of white blood cell (WBC) count, lymphocytes and basophils.


Graphical trend of creatinine.


The manifestations of chest CT. . Notes: (A) Chest CT on admission showed a soft tissue mass in the trachea.


The manifestations of chest CT. (B) Chest CT after radiotherapy showed that the lesion disappeared completely. . Abbreviation: CT, computed tomography.


The bronchoscopic manifestations of the lesion. . Notes: (A) Bronchoscopy revealed two nodular masses with pedicles arising from the posterior wall of the trachea, occluding ~95% of the tracheal lumen.


The bronchoscopic manifestations of the lesion. (B) At the end of 14-month follow-up, repeated bronchoscopy revealed complete recovery of the lesion.


The size of the excised tumor. . Notes: (A) The long axis was 2.3 cm.


The size of the excised tumor. (B) The short axis was 1.5 cm.


Histopathology of the tumor. . Notes: (A) The plasma cells are relatively uniform and most have eccentrically located nuclei (H&E, 400x).


Histopathology of the tumor. (B) The nuclear chromatin is dispersed, and a prominent centrally located nucleolus can be found in each nucleus (H&E, 400x).


Histopathology of the tumor. Immunohistochemical staining showed. Expression of CD38.


Histopathology of the tumor. Absence of CD20.


Histopathology of the tumor. Cytoplasmic lambda light chain positivity.


Histopathology of the tumor. Absence of kappa light chain expression.


Histopathology of the tumor. (G) The MIB-1 (Ki67) index is ~10.


The laryngoscopic manifestations of the tumor. . Notes: (A) Laryngoscopy showed multiple nodules located in the laryngopharynx.


The laryngoscopic manifestations of the tumor. (B) Laryngoscopy after radiotherapy showed two adjacent smooth neoplasms on the back of the soft palate.


Enhanced MRI of laryngopharynx. . Notes: (A) MRI of the nasopharynx showed a round tumor located in the mucosa of the left oropharynx, ~7 mm in diameter, that had homogeneous signal intensity similar to the signal intensity of the mucosa on T1-weighted imaging and was enhanced with contrast.


Enhanced MRI of laryngopharynx. (B) On T2-weighted imaging, the signal intensity of the tumor was moderately higher than that of the mucosa.


Status post recent amputation of the right leg; ongoing necrosis of the left leg despite amputation 5 days before.


Acral necrotic spots.


Postoperative platelet count plotted against aPTT levels.


CT abdomen. Huge right suprarenal mass measuring 16.5 x 6.5 x 8.7 cm.


CT abdomen. Right adrenal mass with break down areas and calcifications.


Presence of chorioretinal lesions in the tapetal fundus OD noted on initial presentation. Images represent central view.


Presence of chorioretinal lesions in the tapetal fundus OD noted on initial presentation. And a view angled to highlight the largest chorioretinal lesion Multifocal pink lesions are noted throughout the tapetal fundus arising from the termination of retinal vessels representing metastatic spread of the hemangiopericytoma. Images obtained with the RetCam Shuttle.


(A): Metastatic spindle cell sarcoma. Subgross photograph. Note the carpet of neoplastic cells in the choroid (arrow) and in the ciliary body (*). Hematoxylin and eosin (H&E).


(B): Tumor in the choroid. Higher magnification of the neoplastic cells near the arrow in Fig. 2A. Cells infiltrate the tapetum (*) and surround choroidal vessels (arrow). (H&E) (Bar = 100 mum).


(C): Tumor in the scleral vessels. Higher magnification of the square in Fig. 2A. Cells surround and infiltrate scleral vessels (arrow). (H&E). (Bar = 100 mum).


Immunohistochemical staining of both the original right flank/limb hemangiopericytoma and the left eye metastasis. Both tissues show positive staining for vimentin and alpha-smooth muscle actin (SMA).


Image of right tapetal fundus two weeks after initial presentation. The presence of numerous large pink/red colored lesions throughout tapetal fundus present near retinal vessel terminations showing significant progression of chorioretinal lesions. Perilesional retinal elevations are seen around each foci of metastasis and appear as halos of reduced reflectivity. Image obtained with the RetCam Shuttle.


Hyponatraemia during anti-MM treatment and response to tolvaptan therapy.


(A and B) Pathological examination of the bone marrow including hematoxylin and eosin (H&E) staining revealed macrophages with intracytoplasmic microorganisms.


Abdominal CT images during trabectedin treatment. A; Disease progression after pazopanib treatment.


Abdominal CT images during trabectedin treatment. B; Second diagnosis of partial remission after 6.5 months of trabectedin treatment (first partial remission observed after 3 months of trabectedin).


Abdominal CT images during trabectedin treatment. C; Disease progression after 22 months of trabectedin treatment. CT, computed tomography; PD, progressive disease; PR, partial remission.


Clinical presentation: tender erythematous papules and plaques. With pustules.


Erosions. Over the lower back and buttocks.


Histopathological features. A; Lesion of acute folliculitis. Note the absence of the marked dermal edema and the hallmark diffuse neutrophilic dermal infiltration usually seen in classic Sweet syndrome. HE, original magnification x50.


Histopathological features. B; Dense neutrophilic infiltrate in the hair follicle. HE, original magnification x200.


Tender erythematous plaques over the lower limbs.


Enhanced chest CT scan axial cut (pulmonary window) showing a large multiloculated cavity lesion involving the right middle lobe and the anterior mediastinum with internal air and fluid.


Clinical course of the patient in the present study. Aza azathioprine, PSL prednisolone, UDCA ursodeoxycholic acid, CsA cyclosporine A, BW body weight, ANA antinuclear antibody, ASMA anti-smooth muscle antibody, IgG immunoglobulin G, ALT alanine aminotransferase, Hb hemoglobin dosage of all medicines is expressed as dose/day.


Clinical presentation of the eyelid eruptions. Well-demarcated, dark-red, partially violet erythemas with small lamellar scales are visible on the patient's bilateral inner and upper eyelid from the frontal view. Mild eyelid edemas are also visible.


Clinical presentation. A dark-red erythematous plaque (approximately 1 cm) is accompanied by pityriatic scales, dark-red partially violet erythemas and coalesced atrophy, which form a large annular eruption on the right side of the patient's face. Pigmentation is visible at the center of the annular erythema, although the scales and erythemas have subsided.


Histopathological findings. Parakeratosis and hyperkeratosis of the horny skin layer as well as hydropic degenerations and vacuolar changes to the basal layer are visible. In the dermis, typical dense lymphoid cells are visible around the follicles or eccrine glands. Hematoxylin and eosin staining, x40.


Clinical phenotype: facial dysmorphia; pinna development deformity; ichthyosis, joint contractures, anasarca; peeling skin on limbs and groin. The black line shows the boundaries of the liver and spleen, indicating hepatosplenomegaly; small microcaulia.


Axial T1 weighted.


Axial FLAIR.


Axial post-gadolinium.


Axial T2 weighted MR images of the CP angle tumor. The lesion is hypointense on T1WI, hyperintense on FLAIR and T2WI, and display enhancement along its periphery and septations. Mass effect on the 4th ventricle is appreciated.


CT scan pulmonary artery study shows minimal bilateral sub-segmental pulmonary embolism.


CT scan thorax shows a left lower lob small infiltration.


CT shows enlarged para-aortic lymph node. Arrow).


Retroperitoneal tumor. Arrow).


After three cycles of BEP, there were marked reduction in para-aortic lymph node (c).


The retroperitoneal tumor was reduced to 20 mm in diameter (d, arrow).


The serum LDH was transiently increased after G-CSF administration in the middle of each course of chemotherapy.


LDH isoenzyme ratios were transiently changed during the third cycle of BEP. The percentages of LDH-3 and LDH-4 were increased after G-CSF use and returned to the normal pattern of isoenzyme ratios when total LDH normalized.


FISH analysis of the bone marrow. Yellow signal indicates negative CRLF2 rearrangement.


FISH analysis of the bone marrow. Two signals of red and green indicate CRLF2 abnormal rearrangement.


Morphological CR status and number of lymphoblasts in the bone marrow at different times. Autologous anti-CD19 CAR T cells bridging with allo-HSCT post CR3. CR4 was obtained followed by sequential of infusion donor-derived anti-CD22 and -CD19 CAR T cells.


Neutrophil with erythrophagocytosis.


Erythrophagocytosis in many neutrophils.


Clinical course of the case. . Note: After the completion of salvage chemotherapy, a severe lymphopenia lasted >5 months until death. . Abbreviation: B-R, bendamustine and rituximab.


Findings of esophagogastroscopy and pathological examination. . Notes: (A) Esophagogastroscopy in normal light observation revealed polynesic white protrusions with shallow ulcers in the mid-esophagus.


Findings of esophagogastroscopy and pathological examination. (B) Shallow ulcers were more apparent by narrow band imaging.


Findings of esophagogastroscopy and pathological examination. (C) Several squamous cells, presenting intranuclear inclusion bodies of Cowdry's type A. Magnification: x100. Inset shows textbook example of Cowdry's type A (green arrowheads). Magnification: x200.


Findings of esophagogastroscopy and pathological examination. (D) These cells with intranuclear inclusion bodies could be positively stained by anti-herpes simplex virus antibody. Magnification: x100.


Slit lamp photograph of patient one shows the sub-Tenons triamcinolone acetonide (Kenalog) prior to the development of severe chorioretinitis (a).


Histopathologic analysis showing toxoplasmosis bradyzoites at 250 x magnification (b, arrows).


Color fundus photo montage of patient one shows a hazy view secondary to vitritis, disc edema, and patchy retinal whitening (c).


While the vitreous inflammation and retinal whitening has improved, optic nerve pallor and retinal vascular attenuation are observed (d).


Color fundus photo montage of the left eye of patient two shows diffuse retinal whitening involving the posterior pole and severe vascular attenuation (a).


With oral and intravitreal anti-parasitic medication, the majority of the retinitis has improved but optic nerve pallor, diffuse retinal pigment epithelial atrophy and severe vascular attenuation are seen (b).


Fundus photograph after 1 week showing whitish yellow appearance of the posterior pole with macular edema.


(a-d) Fluorescein angiography late frames of the periphery of temporal, nasal, and superior quadrants respectively showing complete vascular filling defects. There are focal areas of blocked fluorescence in the temporal quadrant corresponding to the area of retinal hemorrhages.


(a) Fluorescein angiography (FA) of right eye showing normal study.


(b) FA frame 5 min after injection of the dye still shows complete absence of filling in the macular region and faint perivascular and optic disc leak.


(a) T2-W MRI sagittal images disclose a well-defined uniformly hyperintense (identical to CSF) cystic multiseptate lesion extending from the lower end of the T10 vertebral body to the lower end of L2 vertebral body. The bulk of the lesion is seen to create a mass effect and compression over the cauda equina.


(b) T1-W MRI sagittal images after contrast injection reveal a well-defined uniform hypointense multiseptate lesion with no evidence of enhancement within the substance or peripheral wall of the lesion.


(c and d) T2-W MRI axial images, at the level of T12 and L2, disclose well-defined uniform hyperintense lesion with compression and displacement of conus as well as caudal roots at respective levels. The lesion is seen to be extended into intervertebral foramen at the level of T12.


(a) Intraoperative picture (under microscope) after T11-L2 laminectomy. Upper pole of large cystic lesion noted hanging over the underlying intact dura, while the inferior end is extending under L1 lamina which was preserved in tailored exposure.


(b) Distended cyst wall is seen extending into the left neural foramina between T12 and L1 vertebral level.


(c) Distinguished plane between cyst wall and native dura is clearly seen under the cranial pole of the cyst.


(d) Distended cyst wall is seen extending into right neural foramina between T12 and L1 vertebral level.


(a) Intraoperative picture after fenestration and decompression of the cyst, the collapsed wall is seen extending into neural foramina between T12 and L1 vertebral level, where the dural defect was identified and repaired using 4-0 Prolene with muscle patch and fibrin glue.


(b) After complete excision of cyst, dura is noted to be adequately decompressed (no evidence of CSF leak on Valsalva maneuver subsequently).


A well-circumscribed amelanotic iris mass with underlying multiple posterior pigment epithelial cysts.


UBM revealed a hypoechoic mass coalesced with iris stroma with 5.6 mm horizontal diameter and 9.3 mm vertical diameter. . Abbreviation: UBM, ultrasound biomicroscopy.


Final slit-lamp biomicroscopy at 8 months revealed the absence of tumor recurrence.


B-scan ultrasound of the left eye showing a multilobulated vitreous mass occupying practically the entire ocular globe with associated superior choroidal detachment.


Orbital and cranial MRI revealed an intraocular mass with gadolinium enhancement and lacrimal gland enlargement. No signs of CNS metastasis were found.


Patient showing growth on right lower back region with extraoral swelling on right cheek region.


Ulcerative growth seen on the right buccal mucosa measuring about 5 x 6 cm in size extending anteroposteriorly from retromolar area to distal aspect of 46 region.


Increased intraoral growth after 2 months.


Incisional biopsy specimen along with extracted 46, 47 and 48 teeth.


Photomicrograph showing sheets of lymphoid cells (H&E stain, x400).


Photomicrograph showing IHC positivity for CD45 with intense nuclear brown staining for cell membrane surface (IHC stain, x400).


Photomicrograph showing negativity for CD20 staining (IHC stain, x400).


Photomicrograph showing small cell T-lymphocytes positive for CD3 with intense nuclear brown staining for cell membrane surface (IHC stain, x400).


Diffuse acute appendicitis with the intraluminal leukocytes.


Ulceration and infiltration of leukocytes in the mucosa.


Fibrinopurulent exudate on the surface.


Transversal section of the abdominal CT scan revealed an inhomogeneous round tumor of 73 x 61 mm with sharp margins and with hypodense fatty components and enhancing soft tissue.


Laparotomy showed a 10-cm-large tumor, which was completely resected.


Histological section with HE staining of the resected myofibroblastic tumor showing spindle cell proliferation, fibrotic lymph node involvement and central necrosis. Magnification x5,000.


Direct immunofluorescence showing lambda restricted cast nephropathy. Anti-lambda.


Anti-kappa, FITC tagged).


Direct immunofluorescence showing lambda restricted proximal tubulopathy. Anti-lambda.


Pedigree chart for the presence of early-onset sensorineural hearing loss. Green: unaffected members; Red: affected members. Asterisk (*): individuals sequenced for genetic mutation.


Platelet (Plt) counts before and after treatment whit dabigatran.


The clinical course of the present case. R2 Therapy indicates Rituximab and lenalidomide.


Peripheral smear (60x) showing anisopoikilocytosis with occasional teardrops cells and scattered schistocytes.


A. Intraoperative endoscopic view of the sphenopalatine artery (black arrowhead) supplying the mass (black asterisk) and
B. Gross specimen measuring 4.7 x 3.2 x 2.7 cm. Adobe Photoshop CC 20.01 release was used to erase identifying patient details and sharpen the image (applied to entire image 2
B).


An M-peak was noted on serum electrophoresis (A).


This M-protein was revealed to be monoclonal IgG lacking the light chain by immunofixation (B).


Thickened aryepiglottic fold (yellow arrow) suspicious of infiltration.


Recipient's lymphocyte reactivity against HLA class I and II antigens. Recipient lymphocytes had obvious immunoreactivity against donor HLA class I antigens, though reactivity against donor HLA class II antigens was below the threshold level. The threshold level was 1.53 (horizontal lines).


Recipient pre-transplant immunoreactivity against donor antigens, as assessed by FCM. The recipient's lymphocytes clearly show reactivity against donor HLA class I antigens (arrows). The vertical lines represent reactivity against the same antigen in a third party (other recipients).


Serological HLA typing of both the recipient and donor and the recipient's lymphocyte immunoreactivity against specific HLA class I antigens. The recipient was not homozygous for HLA loci. The donor has the HLA-B 55 locus (underlined). The recipient's lymphocytes show specific activity against HLA-B locus 55 (black arrow).


Changes in the patient's blood biochemistry after LDLT. Temporal changes in each of the variables are represented as follows: closed square, AST; closed circle, LDH; open circle, T-Bil; open square, PT-INR; closed triangle, lactate.


Evolution of lung computed tomography scan from patient 1. A) Eighty four days after cord blood transplantation, the scan showed a right hilar mass together with an atelectasis of the right upper lobe leading to the diagnosis of endobronchial post transplant lymphoproliferative disorder.


Evolution of lung computed tomography scan from patient 1. B) Five months later, while the patient had received 3 courses of rituximab and cytotoxic chemotherapy, the scan was normalized.


Histological findings of a bronchial biopsy from patient 1.


The bronchial lamina propria is infiltrated by polymorphic tumoral lymphoid cells (Hematoxylin eosin safran x 100, x 400).


C) Immunohistochemical study shows a positive reaction for the B cell marker CD79a in the tumoral cells (x 400).


D) In situ hybridization with EBERs probes shows that virtually all the tumoral cells are infected by the Epstein Barr virus (x 400).


Xiao Shi, MD.


Multilocular thymic cyst with follicular hyperplasia in a 47- year-old HIV+ female with cough and chest pain. Postero-anterior chest radiograph demonstrates an abnormal contour along the right cardiomediastinal border (arrow).


Multilocular thymic cyst with follicular hyperplasia in a 47 year-old HIV+ female with an anterior mediastinal mass. Axial contrast enhanced chest CT at the level of the heart shows a 7.1 x 2.7 x 8.8 cm lobular lowattenuation mass with heterogeneous enhancement draped across the anterior mediastinum (arrow).


Multilocular thymic cyst with follicular hyperplasia in a 47 year-old HIV+ female with an anterior mediastinal mass. Coronal contrast enhanced chest CT shows low-attenuation cystic areas and enhancing septations (arrow).


Multilocular thymic cyst with follicular hyperplasia. Gross thymectomy specimen from a 47- year-old HIV+ female weighs 180 gram and measures 14.5 cm from medial to lateral, 15 cm from superior to inferior and up to 3.5 cm from anterior to posterior. The gland is very lobulated in appearance with a moderate amount of attached adipose tissue. The gland appears encapsulated with a smooth and glistening pink-purple surface.


CT of metastatic disease. Axial CT of the abdomen and thorax. Multiple contrast-enhancing lesions in the liver with irregular borders typical for metastases (a). Histopathological analysis of a liver metastasis revealed only large, pleomorphic cells (a inset) consistent with a highly malignant dedifferentiated pleomorphic sarcoma. CT of thorax showing multiple round, well-circumscribed lung lesions consistent with metastases.


CT of metastatic disease. Axial CT of the abdomen and thorax. The ground-glass opacity around the lesions may be caused by hemorrhage (b).


CT showing radiological response. Axial CT of the thorax and abdomen showing almost complete radiological response after histological subtype-specific chemotherapy. A small metastatic lesion measuring 5 x 6 mm. Arrow).


CT showing radiological response. Axial CT of the thorax and abdomen showing almost complete radiological response after histological subtype-specific chemotherapy. No other visible metastatic foci in the lungs or the liver. Are seen after chemotherapy.


(A) Papillovesicular lesions on the dorsum of the hand.


(B) Erythematous macules, fluid filled vesicles and crusting lesions on the dorsum of the hand.


Chest x-ray PA digital view did not reveal any major abnormalities except for marginal increase of cardiac size in transverse diameter.


MRI of pelvis (coronal, sagittal, and transverse view) shows large oval well-defined mass lesion occupying whole of pelvis just superior to fundus of uterus (not arising from the uterus indicated by arrow mark).


Photomicrograph showing oval to spindle cells with mild to moderate pleomorphism and high mitotic activity, H & E stain (200X).


Photomicrograph showing tumour cells showing SMA positivity (200X).


Photomicrograph showing tumour cells showing vimentin positivity (20X).


Chest CT scan showing pneumonia.


Computed Tomography and Histological Images of the Pheochromocytoma. A: Abdominal computed tomography showing a left adrenal mass of 50 mm in diameter with rounded, well-defined edges, and hyperdense areas of cystic necrosis inside (asterisk).


Computed Tomography and Histological Images of the Pheochromocytoma. B: Histological panoramic view of the pheochromocitoma. On the left side of the picture there is a normal adrenal gland on which sits the tumor with a large nodule with areas of hemorrhagic aspect, especially in the tumor periphery.


Histological features of ameloblastoma.


Low magnification.


High magnification) and BRAF V600E gene mutation assessed by next-generation sequencing.


3D TOF sequence (RM venography) - Arrows demonstrate the absence of flow at the level of transverse sinus on a distance of 30 mm in the middle third portion, close to the sinus confluence.


Histopathological examination shows the pulmonary nodules were metastatic pheochromocytoma. (A) Hematoxylin and eosin staining of biopsy specimens shows nests of tumor cells separated by vascular septa (Zellballen).


Histopathological examination shows the pulmonary nodules were metastatic pheochromocytoma. Chromogranin.


Histopathological examination shows the pulmonary nodules were metastatic pheochromocytoma. Synaptophysin immunostaining is diffuse strong positive in the tumor cells.


Histopathological examination shows the pulmonary nodules were metastatic pheochromocytoma. (D) CD56 immunostaining is positive in the membrane of the tumor cells.


Histopathological examination shows the pulmonary nodules were metastatic pheochromocytoma. (E) Ki-67 immunostaining shows approximately 5% of cells are positive. Original magnification x 200.


Summarizing scheme of disease progress.


Bone marrow smears of an acute myeloid leukemia without maturation case showing numerous blasts with round nuclei, fine nuclear chromatin, and dark blue cytoplasm (Leishman stain, oil immersion x 100).


GTG-banding in secondary AML-M6 revealed a tetraploid karyotype in 20% of the analyzed cells.


26-year-old female with accelerated hypertension and elevated serum metanephrines diagnosed with pelvic paraganglioma. CECT abdomen axial cut shows heterogeneously enhancing intraluminal growth (arrow) from the left anterolateral wall of the urinary bladder with predominant intraluminal component.


26-year-old female with accelerated hypertension and elevated serum metanephrines diagnosed with pelvic paraganglioma. PET/CT image shows intense tracer uptake and somatostatin receptor expressing lesion (arrow) in the left lateral wall of the urinary bladder.


26-year-old female with accelerated hypertension and elevated serum metanephrines diagnosed with pelvic paraganglioma. Intraoperative image shows tumor arising from the left lateral pelvic wall (arrow) and the bladder appears normal (thin arrow).


26-year-old female with accelerated hypertension and elevated serum metanephrines diagnosed with pelvic paraganglioma. Photograph of the cut specimen of the excised mass shows areas of necrosis in its inferior aspect (arrow).


26-year-old female with accelerated hypertension and elevated serum metanephrines diagnosed with pelvic paraganglioma. Photomicrograph of the tissue on immunohistochemical staining (x10) shows positivity for chromogranin marker, suggestive of pheochromocytoma (arrow).


Ultrasound image of involved lymph nodes.


Fused positron emission tomography-fluorodeoxyglucose (PET-FDG) image before AVD treatment.


HE (magnification 400x).


HE (magnification 100x).


Immunohistochemical staining CD30 (magnification 400x). The stains included anti-CD20, CD3, CD30, CD15, PAX5, MUM-1, Ki-67.


HE immunohistochemical staining (magnification 400x). The stains included anti-CD20, CD3, CD30, CD15, PAX5, MUM-1, Ki-67.


Clinical image showing extra oral view depicting swelling on the right side of the face with asymmetry.


Lateral view showing a single diffuse swelling on right side of the face.


Clinical image shows intra oral view with obliteration of the buccal vestibule.


Orthopantamogram showing mixed radiolucent radio opaque lesion.


Histopathological image showing odontogenic epithelial islands arranged as thin cords (H&E, x100).


Histopathological image showing compression of odontogenic epithelial islands due to extensive stromal desmoplasia (H&E, x200).


Gross specimen.


Histopathological image showing odontogenic epithelial islands with a prominent vascular component (H&E, x100).


Histopathological image showing typical plexiform ameloblastomatous component interspersed with large blood filled spaces (H&E, x200).


Histopathological image showing ameloblastomatous component with endothelial lined channels and engorged red blood cells (H&E, x400).


Nonhomogeneous mass lesion was located in the right lung.


Mass lesion was located in the right lung.


Postcardiopulmonary bypass picture showing thrombus in the venous reservoir attached to the mesh material.


Clinical picture showing the extent of proptosis in the right eye.


Positive deck-chair-sign (arrows) skin eruption on the trunk of patient 1 , who was found to have Sezary syndrome.


On the trunks of patients 2-5 , who were diagnosed with mycosis fungoides / cutaneous T-cell lymphoma with evidence of blood involvement.


CGMS tracings from individual days, demonstrating (a) maintenance of euglycemia throughout the day.


In the setting of pump dysfunction (b), overnight glucagon delivery ceased, precipitating hypoglycemia.


CGMS tracings taken over 1 week after initiation of everolimus. Each color represents an individual day.


CT scan of causative upper right quadrant mass (indicated with dashed line). Scale = 5 cm.


First Patient. A. Pre-operative tracing of lymphatic.


First Patient. B. Intra-operative visualization of dye-injected lymphatic.


First Patient. C. Post-surgical closure and resolution.


Second patient. A. Pre-operative effluence from incision-site.


Second patient. B. Intra-operative visualization of dye-injected lymphatic.


Second patient. C. Drain placement and closure.


Second patient. D. Post-operative resolution.


Third patient. A. Intra-operative dye injection of superficial dorsal lymphatic.


Third patient. B. Serous fluid accumulation due to chromium allergy.


(A) On admission.


(B) Two weeks after treatment.


(A) IgG staining.


(B) IgG4 staining.


PET-CT showed high glucose intake in salivary glands, lymph nodes, liver, and spleen.


Massive pericardial effusion with right ventricular collapse.


Plethoric inferior vena cava.


Globally expanded heart. After pericardiocententesis.


Chronological cystatin C estimated glomerular filtration rate and haptoglobin measurements from the time of admission. Vomiting is marked according to its duration and eculizumab treatments are marked with arrows.


Clinical photograph (after biopsy) of case 1 showing residual ulcerated light red plaque on medial aspect of left leg.


Photomicrograph (low power) showing diffuse nonepidermotropic infiltrates of tumor cells in the papillary and reticular dermis (Hematoxylin and Eosin, x100).


Photomicrograph showing CD20 positivity (cytoplasmic membrane) by tumor cells (x400).


Photomicrograph showing Bcl-6 positivity (nuclear) by tumor cells (x100).


Photomicrograph (high power) showing monomorphic large cells arranged in diffuse sheets. The cells have the high nuclearcytoplasmic ratio and prominent single to multiple nucleoli (Hematoxylin and Eosin, x400).


Overview of eGFR, proteinuria and ratio of predicted eculizumab concentrations related to the eculizumab treatment in time. (A) Estimated eGFR (Schwartz formula) indicated with dark grey line, and the various interval treatment periods of eculizumab, indicated by the legends: white bar: eculizumab 1200 mg weekly middle grey colored bar: four-weekly 1200 mg eculizumab; light-grey colored bar 6-weekly 1200 mg eculizumab; dark grey colored bar: two-weekly 1200 mg eculizumab. Dotted line indicates the annual eGFR decline of 22.9 ml/min/1.73m2 (baseline eGFR 68 ml/min/1.73m2).


Overview of eGFR, proteinuria and ratio of predicted eculizumab concentrations related to the eculizumab treatment in time. (B) Urine Protein-to-Creatine ratio (g/10 mmol) in time indicated with dark grey line. Ratios of predicted eculizumab concentrations of our patient and a standardized patient of same weight indicated with dots. Ratio =1 (horizontal dotted line), normal clearance; Ratio >1, decreased clearance in our patient (eculizumab concentrations higher than expected); Ratio <1; increased clearance in our patient (eculizumab concentrations lower than expected.


Sequence chromatogram of the
TRIP11-PDGFRB
fusion junction showing the fusion between exon 16 of
TRIP11
and exon 11 of
PDGFRB. Black arrows indicate the location of primers. The white arrow indicates the location of breakage and reunion. E: exon.


Lesions before thalidomide.


Lesions after thalidomide.


Spleen tissue biopsy, infiltration of red pulp cords, sinusoids
and scattered residual white pulp islands by sheets of pleomorphic
large cells resembling popcorn cells.


Spleen tissue biopsy, positive for CD20.


Spleen tissue biopsy, positive for CD3.


Spleen tissue biopsy, positive for BCL-2.


Spleen tissue biopsy, positive for CD30.


Spleen tissue biopsy, positive for CD34.


Spleen tissue biopsy, negative for CD15.


Spleen tissue biopsy, negative for EMA. Bone marrow Biopsy revealed thin anastomosing bony trabeculae separating 15 hematopoietic spaces with normal cellularity (60%)(3/5)(Figure 9).


Familial Pedigree of case. The proband is indicated by an arrowhead. Squares represent males, circles represent females. Solid symbols represent affected individuals. Symbols with slash indicate deceased individuals. Age at cancer diagnosis is reported following the corresponding disease and the age of death is reported on the top right corner of symbol. GC, gastric cancer; CRC, colorectal cancer; OC, ovarian cancer; LC, lung cancer.


Demonstration of NGS results of APC and BRCA1 germline mutations. The heterozygous loss of exon 15 in APC gene was detected in the proband.


Demonstration of NGS results of APC and BRCA1 germline mutations. The same heterozygous loss of exon 15 in APC gene was also detected in the 20-year old male patient.


Demonstration of NGS results of APC and BRCA1 germline mutations. The heterozygous p. Lle1824AspfsX3 in BRCA1 gene was detected in the 20-year old male patient.


Panel a: Posteroanterior chest radiograph, (illness day 10, hospital day 1), showing bilateral lungs opacities and infiltrates. Panel b: A chest computed tomography scan, (illness day 11, hospital day 2), revealing a bilateral multi-segmental ground glass and consolidative opacities (centrally and mainly peripherally).


Parameters during dissection.


Tumor after dissection.


CT scan of the abdomen showing a thickened soft tissue rind of perinephric tissue (yellow arrow), infiltration of the retroperitoneum in the paraaortic and interaortocaval spaces (blue arrow), as well as encasement of the superior mesenteric artery (pink arrow).


Chest X-ray showed left diaphragm elevation.


Abdominal CT scan showed infarcts and abscess regions in spleen with splenomegaly.


Splenectomy image that showed multiple infarct and abscess.


Nonreacting, dilated pupil.


Multifocal exudative retinal detachment with macular edema. In the right eye.


Left eye with circumciliary congestion, edematous cornea, and fibrinous exudates with hyphema in anterior chamber.


Subcutaneous ulcerated nodule in the scalp.


Papulomacular rashes and nodules on the arm and trunk.


Histopathological examination of skin showing dense cellular infiltrate composed of histiocytes, lymphocytes, and occasional eosinophils. . Note: Arrow: the histiocytes have scanty cytoplasm, a nucleus with coffee bean appearance and prominent nucleoli with mitosis.


Preoperative magnetic resonance imaging and digital subtraction angiography. Preoperative axial.


Preoperative magnetic resonance imaging and digital subtraction angiography. Sagittal. Views in gadolinium-enhanced T1-weighted MRI, showing a prominent enhanced mass lesion and enhanced vessel-like structures in surrounding parenchyma in the left cerebellar hemisphere.


Preoperative magnetic resonance imaging and digital subtraction angiography. Anteroposterior.


Preoperative magnetic resonance imaging and digital subtraction angiography. Lateral. Views in angiography, showing strong tumor staining with a feeding artery from the left posterior inferior cerebellar artery, and ,a draining vein into the left inferior vermian vein.


Preoperative magnetic resonance imaging and digital subtraction angiography. Indicating arteriovenous shunt [anteroposterior view.


Preoperative magnetic resonance imaging and digital subtraction angiography. Lateral view.


(Case 2) White arrow-well-defined mid cheek, infrazygomatic, mass lesion with no evident facial nerve palsy; inset-lateral view.


(Case 2) Intraoperative findings of the tumor in accessory lobe of parotid with splayed zygomaticotemporal branch and its relation to the Stensen's duct.


(Case 2) Postop status with the evident "hallow mid cheek" (thin arrow). Modified Blair's incision for excision of tumor with superficial parotidectomy (thick arrow).


(Case 2) 6 months post op showing complete recovery of facial nerve palsy.


(Case 2) HPE-salivary gland parenchyma with infiltrating malignant cells arranged in diffuse sheets and involving the circumferential resected margins. Inset-round to oval cells with hyperchromatic nucleus. S/0- Diffuse small cell type NHL (H&E x20; inset, x400).


(A) Scalp VEEG showed seizure onset with the consciousness loss with head-turning to the left was located on the right anterior area with low-voltage fast activities.


(B) SEEG demonstrated that inter-ictal discharges emerged only within the temporal lobe (nodes A8-11, B6-7, B11-12, D7-9, and E4-5).


(C) SEEG showed that GS started within the right hippocampus (nodes D7-9 and E4-5) with spike-waves in fast activities. Seizure activities were not recorded, either during the inter-ictal period or during the seizure procedure, in nodes within the remaining HH.


Findings under electronic colonoscope. Ascending colon mass in. The first colonoscopy.


Findings under electronic colonoscope. The second colonoscopy.


Histological appearance of ascending colon mass. Hematoxylin, and . Eosin stain of. High-grade intraepithelial neoplasia in the first biopsy.


Histological appearance of ascending colon mass. Adenocarcinoma in the second biopsy. Magnification, x200.


Extraoral photograph of patient.


Clinical photograph showing. Gingival swelling on palatal aspect of 54.55.


64.65. Diffused.


Erythematous ulcerated gingival swelling covered with necrotic slough over buccal aspect of 64.65.


Gingival swelling with tiny bleeding spots over buccal aspect of 75 and 85.


(a and b) Intraoral radiograph showing radiolucent lesion surrounding root of 55, 74 and 75.


Orthopantomogram revealed multiple areas of bone loss in the left mandibular region.


(a and b) Axial and coronal computed tomography revealed multiple soft tissue density lesions with irregular and punched out bony destruction noted involving left mandibular, left side of occiput, right maxillary and right temporal bone.


Three-dimensional computed tomography revealed multiple osteolytic lesions in relation to maxillary alveolar process, body and ramus of left side of mandible.


Histopathological picture showing diffuse infiltrate of Langerhans cell with eosinophils (H&E stain, x40).


Computed tomography images of the illustrative case. (a-c) Preoperative nonenhanced bony computed tomography revealing calcification including an osteolytic lesion. Coronal view revealing a lytic lesion that occupied the condyle and C1 lateral mass. Sagittal view showing the lytic lesion which extends to the upper clivus.


Preoperative magnetic resonance images revealing that the lesion had low intensity on T1- and T2-weighted images. The lesion is enhanced heterogeneously by gadolinium administration. T1-weighted image.


Preoperative magnetic resonance images revealing that the lesion had low intensity on T1- and T2-weighted images. The lesion is enhanced heterogeneously by gadolinium administration. T2-weighted image.


Preoperative magnetic resonance images revealing that the lesion had low intensity on T1- and T2-weighted images. The lesion is enhanced heterogeneously by gadolinium administration. Gadolinium-enhanced image.


Intraoperative photographs of the illustrative case. An endoscopic endonasal transclival approach is performed to confirm the pathological finding and to decompress the left lower cranial nerves. (a) The lesion below the sellae turcica is exposed. The lesion is hemorrhagic and white-yellow in color, and consists of relatively soft tissue.


Intraoperative photographs of the illustrative case. An endoscopic endonasal transclival approach is performed to confirm the pathological finding and to decompress the left lower cranial nerves. (b) The lateral side of the lesion is resected until the bilateral internal carotid arteries are exposed.


Intraoperative photographs of the illustrative case. An endoscopic endonasal transclival approach is performed to confirm the pathological finding and to decompress the left lower cranial nerves. (c) The upper side of the lesion near the dorsum sellae is drilled out.


Intraoperative photographs of the illustrative case. An endoscopic endonasal transclival approach is performed to confirm the pathological finding and to decompress the left lower cranial nerves. (d) Near the left lateral side of the lesion, the left hypoglossal canal is opened.


Postoperative nonenhanced bony computed tomography images of the illustrative case: (a-c) The lesion is resected between the dorsum sellae and lower clivus without the condyle joint.


Pathological findings (H and E): (a) Multinucleated giant cells surrounding the focal hemorrhage are seen. (x100) (b) Abundant spindle-shaped fibroblast cells and multinucleated giant cells are present ( x200).


Hyperpigmented, indurated plaques with marked hypertrichosis arranged symmetrically over medial aspect of thighs, and ,legs.


Hyperpigmented hypertrichotic indurated plaques over lower back and sacral area.


Hallux valgus deformity of both great toes seen.


Mammogram performed with mediolateral oblique incidences of both breasts shows multiple oval well-defined masses located in the right breast.


A round lesion with fine spiculated borders located on the superior quadrant of the left breast. Associated with smaller round lesions.


Dense myeloid precursor proliferation with breast tissue invasion. Immunostaining is positive for myeloperoxydase, CD68 and CD117, which are markers for myeloid cells.


Gadolinium-enhanced T1-weighted images with fat saturation showing a remaining 1-cm focal enhancement 1 month after therapy (arrow).


Lateral skull X-ray shows multiple well-circumscribed lytic punched-out round lesions (blue arrows).


Axial CT abdomen bone window shows lytic lesions in the vertebral body (upper blue arrow) and right transverse process (lower blue arrow).


Axial CT pelvis bone window shows lytic lesion in the right ischial bone (blue arrow).


Sagittal CT abdomen and pelvis bone windows shows two lytic lesions in T12 (upper blue arrow) and L3 (lower blue arrow) vertebra.


MRI showing expansile osseous lesion seen along the floor of posterior cranial fossa involving the posterior portion of right petrous temporal bone.


CT-Temporal bone showing locally destructive lesion involving the right mastoid air cells with disruption and erosion of the right temporal bone.


Microphotograph showing diffuse sheets of plasma cells. (Hematoxylene and Eosin stain).


Immunohistochemisty for CD 138 showing strong positivity in tumor cells.


Facial asymmetry and a firm swelling in the area of the left mandibular ramus region extending to the base of the mandible.


Radiograph showing radiolucency extending till the base of mandible surrounding the crown of the unerupted third molar resembling the dentigerous cyst.


Histological slide confirmed the diagnosis of a plexiform ameloblastoma.


Extraoral incision and retraction of the left mandibular ramus region.


Sectioning of the mandible.


Sectioned mandible maintaining a safe margin of 1.5 mm of uninvolved bone.


Contralateral sixth rib was harvested as a costochondral graft through inframammary incision.


Costochondral graft secured into place in continuation with the distal end of resected mandible.


Costochondral graft secured into place by means of reconstruction plate.


After a week, patient was recalled for the check-up.


Radiograph to ensure the stability of the graft.


MRI FLAIR. . Notes: MRI FLAIR sequencing through the. Cerebellum.


MRI FLAIR. Frontal lobes shows cortical and subcortical lesions.


MRI FLAIR. One lesion. In the left posterior frontal lobe enhanced with contrast, and ,bright on FLAIR also showed hypointensity on T1 signaling.


MRI FLAIR. Was. Found to have calcification on the CT scan. DWI MRI (not shown) was negative for acute infarction. . Abbreviations: MRI, magnetic resonance imaging; FLAIR, fluid-attenuated inversion-recovery; DWI, diffusion weighted imaging.


Contrast-enhanced abdominal CT-scan. . Note: Demonstrates a 3.5x3.0x3.0 cm enhancing lobulated-noncalcified mass (asterisk) in the right adrenal gland. . Abbreviation: CT, computed tomography.


Histopathology specimen of resected adrenal tumor. . Notes: (A) Tumor arising from the medulla (asterisk) compressing the adrenal cortex (H&E, x40).


Histopathology specimen of resected adrenal tumor. (B, C) High magnification (H&E, x200 and x400) shows whorl-like nests of tumor cells surrounded by a fibrovascular stroma (asterisks). . Abbreviations H&E, hematoxylin and eosin.


Automated visual fields, fundus of both eyes, sequential axial FLAIR MRI. . Notes: Six months after resection of the adrenal tumor, automated visual fields and fundus of both eyes improved (A, B).


Automated visual fields, fundus of both eyes, sequential axial FLAIR MRI. The sequential axial FLAIR MRI shows diminished size and signal of cortical and subcortical lesions (C). . Abbreviations: FLAIR, fluid-attenuated inversion-recovery; MRI, magnetic resonance imaging.


Fundus photograph, fluorescein angiogram. . Notes: Fundus photograph of the right eye shows a vascular dilation (A, asterisk).


Fundus photograph, fluorescein angiogram. Fluorescein angiogram of the right eye shows two small hemangioblastomas (B, C).


Fundus photograph, fluorescein angiogram. Fluorescein angiogram of the right eye shows two small hemangioblastomas (B, C). Note the feeder artery and draining vein (C).


Right lateral thoracic radiographs. Prior to treatment, and . This finding is not evident in (A).


After 4 years of treatment for MUO. (B) Mineralization in the right and left pulmonary arteries (arrow) is seen as an elongated heterogeneous mineral opacity overlying and extending slightly dorsal and ventral to the carina.


Reconstructed. Dorsal.


Three-dimensional (3D) computed tomographic images obtained post-mortem show amorphous mineral attenuation within the right and left pulmonary arteries (arrows).


Bone marrow biopsy findings. (A) Biopsy section (H&E), at low magnification (20x) showing infiltration by abnormal lymphoid cells.


Bone marrow biopsy findings. (B) CD56 immunostain highlighting marked increase in NK cells (50x).


Bone marrow biopsy findings. Reticulin stain highlighted an increase in reticulin fibrosis (50x).


Bone marrow biopsy findings. Trichrome stain highlighting focal bundles of collagen deposition (50x).


Megakaryocytic atypia and anisocytosis. Biopsy section (reticulin stain) showing megakaryocytic atypia with small clusters.


Megakaryocytic atypia and anisocytosis. CD61 immunostain showing megakaryocytic clustering (10x).


Megakaryocytic atypia and anisocytosis. CD61 immunostain showing anisocytosis (50x).


Immunohistochemistry performed on bone marrow biopsy section (20x). The lymphoid infiltrate is positive for CD3 (epsilon).


Immunohistochemistry performed on bone marrow biopsy section (20x). , negative for CD5.


Immunohistochemistry performed on bone marrow biopsy section (20x). , positive for CD56.


Immunohistochemistry performed on bone marrow biopsy section (20x). Positive for EBV.


Trends of serum cytokines, body temperature, and major blood biochemical indexes after CART123 infusion. (A) Cytokines changed after CART123 infusion. Serum cytokine levels were measured at the indicated time points before or after CART123 and PBSC infusions.


Trends of serum cytokines, body temperature, and major blood biochemical indexes after CART123 infusion. (B) Changes in body temperature after CART123 infusion.


Trends of serum cytokines, body temperature, and major blood biochemical indexes after CART123 infusion. (C) Changes in CRP and LDH levels after G-PBSC infusion. CART123, CD123-targeted chimeric antigen receptor (CAR) T cell; PBMC, peripheral blood mononuclear cell; IL, interleukin; IFN, interferon; TNF, tumor necrosis factor; CRP, C-reactive protein; ALT, Alanine transaminase; aGVHD, acute graft-vs-host disease; CsA, Cyclosporine A; MMF, mycophenolate mofetil; GC, glucocorticoids; UCB-MSC, umbilical cord blood mesenchymal stem cells; DIC, disseminated intravascular coagulation; LDH, lactate dehydrogenase; Cre, creatinine; TBiL, total bilirubin; DBiL, direct bilirubin.


Trends of serum cytokines, body temperature, and major blood biochemical indexes after CART123 infusion. (D) Changes in Cre, TBiL, DBiL, and ALT levels after G-PBSC infusion.


T2-weighted sagittal magnetic resonance image showing a hyperintense extradural lesion at the eighth thoracic spinal segment.


Intestinal wall thickening in the axial slice of abdominopelvic CT.


Clinical course from conventional chemotherapy (mLSG-15) to allogeneic peripheral blood stem cell transplantation. The patient received four sessions of mLSG-15 therapy and achieved complete remission (CR) before receiving allo-PBSCT.


Clinical course after onset of the neurogenic disorder. The patient developed paraplegia 14 months after allo-PBSCT. Neurological findings were partially relieved following treatment with a high dose of mPSL accompanied by intrathecal injection of MTX + Ara-C + PSL and irradiation of the whole brain and spine. Three months later, her neurological deficit worsened again. Ultimately, her neurological disorder improved after treatment with a high dose of steroid.


CSF findings. A) Flow cytometric analysis of CSF. Before treatment, the CD4 + CXCR3 + CCR4+ cell population was predominantly elevated. Following treatment, it decreased and the CD4 + CXCR3 + CCR4- cell population increased.


CSF findings. B) Neopterin and CXCL10 (IP-10) concentrations in CSF. Before treatment, both neopterin and CXCL10 (IP-10) concentrations were significantly elevated. Following treatment, both biomarkers decreased to within the range of the therapeutic goal for HAM patients.


Periorbital swelling of the right eye without erythema or pain.


The magnetic resonance imaging of the orbit. (A) Axial T2-weighted post-contrast images showed a mildly enhanced mass compressing the adjacent right lateral rectus muscle and the globe.


The magnetic resonance imaging of the orbit. (B) Coronal T2-weighted post-contrast images showed an extra-conal lesion, which was well-defined and iso-intense as the lateral rectus muscle.


Marrow biopsy was done for increased blasts in peripheral blood and disclosed hypercellular marrow with around 80% cellularity. In HPF (X400) view, there was increased myeloid series and more than 20% blasts, indicating acute leukemia transformation.


A; Color fundus photograph of the right eye showing hemiretinal vein occlusion with flame-shaped and dot hemorrhages in areas drained by the affected vein.


B; Fluorescein angiogram showing multiple areas of hypofluorescence due to intraretinal hemorrhages and subtle leakage of dye in the foveal area, with no signs of perfusion.


C; OCT image demonstrating a subtle perifoveal edema.


D; OCT image after a single application of intravitreal ranibizumab, demonstrating resolution of the perifoveal fluid.


Selected axial T1 weighted images from brain MRI with contrast (A,B). (A) Diffuse gyriform leptomeningeal enhancement on both cerebral hemispheres.


Selected axial T1 weighted images from brain MRI with contrast (A,B). (B) Enhancement of the cisternal portion of the right 6th cranial nerve (arrow).


Brain biopsy (A) Low power view of the brain cortical biopsy showing cellular deposits on the meningeal surface.


Brain biopsy (B) The cellular foci comprise many large atypical cells.


Brain biopsy (C) The latter are positive for CD79a.


Brain biopsy (D) CD3 stains many admixed small T cells.


Brain biopsy (E) Ki67 stains the nuclei of most large cells.


CSF (F) CSF contains a few large atypical cells and many small lymphocytes.


Brain autopsy. (A) Low power view of leptomeningeal spaces enlarged by a dense cellular infiltrate.


Brain autopsy. (B) The infiltrate comprises scattered large lymphoid cells (arrows), numerous small lymphocytes, and histiocytes.


Brain autopsy. (C) CD79a highlights the large atypical B cells (arrows).


Brain autopsy. (D) CD68 underscores the histiocyte-rich background.


Glomeruli showing expansion of mesangial matrix with mild increase in mesangial cellularity. Interstitial inflammation seen [Periodic Acid Schiff stain, 40X].


Computed tomography angiogram showing a tumor situated in front of the left kidney. The left kidney and adrenals are normal.


(a) A cluster of tumor cells showing indistinct cell borders, abundant granular eosinophilic cytoplasm and anisokaryosis (H and E, x400). (b) Occasional binucleate and spindle cells are seen (PAP, x400).


(a) Cell block showing classical features of pheochromocytoma (H and E, x400). (b) Tissue section shows tumor cells arranged in the characteristic Zellballen pattern (H and E, x400).


Chest X-ray upon first admission. . Cardio-mediastinal silhouette is within normal limits with the heart being normal in size. . No pleural effusion / pneumothorax/consolidative patches identified.


Chest X-ray upon his most recent admission. . Mildly prominent hilar vascular markings identified (red arrows) with minimal blunting of the left costophrenic angle (blue arrows) and mild elevation of the left hemidiaphragm. But Cardio-mediastinal silhouette.


Chest CT upon recent admission. . Congestive pulmonary changes in the form of ground glass opacities and pleural effusion at the posterior inferior aspects of both lungs, more on the left. (Arrow heads) Circumferential pericardial effusion (red arrow).


Pleural and Pericardial Biopsy Histopathology report. . A. Light microscopic view showing well-defined epithelioid granuloma engulfing parasitic egg (H&E x400).


Pleural and Pericardial Biopsy Histopathology report. . B. The cuticle of the parasitic egg is polarizable (H&E x400 with polarizer/analyzer lens).


Haemoglobin H staining with brilliant cresyl blue. Arrows: erythrocytes with golf ball inclusions.


Haemoglobin electrophoresis chromatography. Haemoglobin A 92.1%, haemoglobin A2 1.7%, haemoglobin H 6.2%.


CT imaging of the maxillofacial region shows a heterogeneous mass over the left side of the nasal dorsum and frontal process of the left maxilla.


Photomicrograph showing acellular material arranged as nodules (Congo red, 20x).


The tumor markers after treatment with Herceptin combined with chemotherapy. CA125.


The tumor markers after treatment with Herceptin combined with chemotherapy. NSA.


The tumor markers after treatment with Herceptin combined with chemotherapy. CYFR-211. Decreased after treatment with Herceptin combined with chemotherapy.


Brain masses observed by brain computed tomography before and after treatment.


Timeline of events since diagnosis and summary of administered treatments.


Cytogenetic result of unstimulated bone marrow samples showing 47,XX, +4, t(8;21) in all metaphase plates.


(A) A metaphase cell following FISH with LSI AML-ETO (Abbott Molecular, USA).


(B) Whole chromosome paint probe 4 with spectrum Orange (Abbott Molecular, USA).


Magnetic resonance imaging (MRI) study of head and neck. A, Axial MRI scan showing a significantly increased signal of the bone marrow lesion (yellow arrow) when compared with left mandibular body (asterisk), with bone edema indicative of an inflammatory process taking place in the right mandibular body and gas tracking along the two pterygoid muscles (white arrows).


Magnetic resonance imaging (MRI) study of head and neck. B, A coronal T2-weighted image of the submandibular region showing a wide mass with very high signal intensity from the parapharyngeal space to the inferior cervical region with associated edema.


A 45-year-old female patient presenting with diffuse swelling over left side of face.


Well defined gingival mass over left posterior teeth region.


Histopathology is suggestive of atypical lymphoid cells arranged in diffuse sheets in a delicate connective tissue stroma containing scattered hemosiderin pigmentation.


Radiographs suggestive of irregular bony destruction in maxillary left posterior teeth region. Well defined enhancing soft tissue lesion involving left maxillary alveolus and gingivobuccal sulcus, causing erosion of posterolateral wall of left maxillary sinus and extending into the left nasal cavity can be appreciated.


The hematoxylin-eosin (H&E) and immunohistochemical pictures of the tumor. (A) H&E, original magnification, x100.


The hematoxylin-eosin (H&E) and immunohistochemical pictures of the tumor. (B) H&E, original magnification, x400.


The hematoxylin-eosin (H&E) and immunohistochemical pictures of the tumor. (C) Immunohistochemical staining for CD68.


The hematoxylin-eosin (H&E) and immunohistochemical pictures of the tumor. (D) Immunohistochemical staining for CD163.


The hematoxylin-eosin (H&E) and immunohistochemical pictures of the tumor. (E) Immunohistochemical staining for S100.


Imatinib could inhibit MAPK and PI3K/AKT pathways in vitro. (A-C) Cells were exposed to different concentrations of imatinib, thalidomide (THD), and imatinib + thalidomide. Cell viability was assessed using CCK8 assays after treatment for 24 h. Data were obtained from three independent experiments. *
p < 0.05, **
p < 0.01, ***
p < 0.001 vs. Each control group.


Imatinib could inhibit MAPK and PI3K/AKT pathways in vitro. (D) KEGG pathway enrichment analysis of gene mutations in patient.


Imatinib could inhibit MAPK and PI3K/AKT pathways in vitro. (E) Representative immunohistochemistry staining images of p-AKT, p-JNK, and p-ERK in patient's tumor tissues (magnification, x200).


Imatinib could inhibit MAPK and PI3K/AKT pathways in vitro. (F) Total proteins were collected from the treated DH82 cells, and Western blot analyses for the expression of p-AKT, AKT, p-JNK, JNK, p-ERK, and ERK were performed. GAPDH was used as a loading control. Data were obtained from three independent experiments. ***
p < 0.001 vs. Each control group.


AP skull X-ray showing thickening of diploic space.


Lateral skull X-ray showing thickening of diploic space.


Brain CT scan (bony window) showing external and internal skull Tables and diploic space thickening.


Brain CT scan (soft tissue window) showing a hyperdense paraventricular mass with peripheral edema.


Contrast-enhanced brain CT scan showing an intense enhancible paraventricular mass.


Axial T1-W brain MRI revealing a hyperintense paraventricular mass.


Axial T2-W brain MRI showing a hypointense paraventricular mass with hyperintense peripheral edema.


Sagittal contrast-enhanced T1-W brain MRI revealing an intense homogeneous enhancible paraventricular mass.


Calcium level during pregnancy, after delivery, and 6 months after delivery.


The gross appearance of freeze-dried PRP and its application to the wound. (a) Freeze-dried PRP preserved in a 1.5-mL microcentrifuge tube.


The gross appearance of freeze-dried PRP and its application to the wound. (b) Freeze-dried PRP was reconstituted to the original PRP volume with the normal saline solution, and 2 mL of reconstituted PRP was applied and covered with a gelatin sheet. PRP indicates platelet-rich plasma.


Normalization of CD4:CD8 ratio followed by increase of CD3+ donor chimerism after alloHSCT confirming graft-vs-Sezary effect.


Histopathology. (A) Hematoxylin and eosin stain sections show the cortex with reactive astrocytes.


Histopathology. (B) Perivascular lymphocytic infiltrate.


Histopathology. (C) Luxol fast blue staining for myelin shows no significant myelin loss.


Histopathology. (D) Immunohistochemistry with antiglial fibrillary acidic protein antibody highlights numerous reactive astrocytes. MIB 1 staining showed a proliferation index of less than 1%; p53 was negative (not shown). IDH1/2 mutation was not detected.


MRI of the brain after the lesionectomy. (A) Seven months after onset of EPC, T2 FLAIR sequence shows an area of encephalomalacia over the right frontal cortex in the region of surgery.


MRI of the brain after the lesionectomy. (B) Twelve months after onset of EPC, T2 FLAIR sequence shows stable postsurgical changes over the right frontal cortex in the region of surgery despite the worsening of EPC.