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Peripheral T-Cell Lymphoma: Spectrum of Imaging Findings with Clinical and Pathologic Features¹

¹ From the Department of Radiology, Gachon Medical School, Gil Medical Center, Inchon, Korea (H.J.L.); and the Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea (J.G.I., J.M.G., K.W.K., B.I.C., K.H.C., J.K.H., M.H.H.). Recipient of a Certificate of Merit award for an education exhibit at the 2001 RSNA scientific assembly. Received February 8, 2002; revision requested April 25 and received May 16; accepted May 17. Address correspondence to J.M.G. (e-mail: jmgoo@plaza.snu.ac.kr).

View larger version (171K): [in a new window]   Figure 1a.  Nasal-type extranodal NK/T-cell lymphoma involving the nasal cavity in a 42-year-old woman. (a) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) of a nasal mucosal biopsy specimen shows intense infiltration of atypical lymphoid cells into the vascular intima and subintima (arrow). This is a typical appearance of angiocentric invasion in which the vascular lumen (V) is nearly obstructed. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of NK-cell marker (CD56)-labeled tissue shows that atypical lymphoid cells react positively with the marker and appear brown. (c) Photomicrograph (original magnification, x600; in situ hybridization of Epstein-Barr virus on paraffin-embedded material) shows cells labeled with Epstein-Barr virus DNA (arrows).

View larger version (173K): [in a new window]   Figure 1b.  Nasal-type extranodal NK/T-cell lymphoma involving the nasal cavity in a 42-year-old woman. (a) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) of a nasal mucosal biopsy specimen shows intense infiltration of atypical lymphoid cells into the vascular intima and subintima (arrow). This is a typical appearance of angiocentric invasion in which the vascular lumen (V) is nearly obstructed. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of NK-cell marker (CD56)-labeled tissue shows that atypical lymphoid cells react positively with the marker and appear brown. (c) Photomicrograph (original magnification, x600; in situ hybridization of Epstein-Barr virus on paraffin-embedded material) shows cells labeled with Epstein-Barr virus DNA (arrows).

View larger version (165K): [in a new window]   Figure 1c.  Nasal-type extranodal NK/T-cell lymphoma involving the nasal cavity in a 42-year-old woman. (a) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) of a nasal mucosal biopsy specimen shows intense infiltration of atypical lymphoid cells into the vascular intima and subintima (arrow). This is a typical appearance of angiocentric invasion in which the vascular lumen (V) is nearly obstructed. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of NK-cell marker (CD56)-labeled tissue shows that atypical lymphoid cells react positively with the marker and appear brown. (c) Photomicrograph (original magnification, x600; in situ hybridization of Epstein-Barr virus on paraffin-embedded material) shows cells labeled with Epstein-Barr virus DNA (arrows).

View larger version (133K): [in a new window]   Figure 2a.  Nasal-type extranodal NK/T-cell lymphoma in a 40-year-old woman. (a) Axial T2-weighted MR image shows a low-signal-intensity mass that fills the left nasal cavity and thickening of the medial wall of the maxillary sinus (arrow). The mass had intermediate signal intensity on T1-weighted MR images. (b) Axial contrast material-enhanced MR image shows diffuse enhancement of the mass. Nonenhancement of a portion of the tumor (black arrow) is suggestive of necrosis. Note the thickening and enhancement of the medial wall of the left maxillary sinus (white arrow), an appearance suggestive of tumor infiltration. (c) Coronal contrast-enhanced MR image shows diffuse spread of the tumor in the left ethmoid sinus and left nasal cavity.

View larger version (144K): [in a new window]   Figure 2b.  Nasal-type extranodal NK/T-cell lymphoma in a 40-year-old woman. (a) Axial T2-weighted MR image shows a low-signal-intensity mass that fills the left nasal cavity and thickening of the medial wall of the maxillary sinus (arrow). The mass had intermediate signal intensity on T1-weighted MR images. (b) Axial contrast material-enhanced MR image shows diffuse enhancement of the mass. Nonenhancement of a portion of the tumor (black arrow) is suggestive of necrosis. Note the thickening and enhancement of the medial wall of the left maxillary sinus (white arrow), an appearance suggestive of tumor infiltration. (c) Coronal contrast-enhanced MR image shows diffuse spread of the tumor in the left ethmoid sinus and left nasal cavity.

View larger version (159K): [in a new window]   Figure 2c.  Nasal-type extranodal NK/T-cell lymphoma in a 40-year-old woman. (a) Axial T2-weighted MR image shows a low-signal-intensity mass that fills the left nasal cavity and thickening of the medial wall of the maxillary sinus (arrow). The mass had intermediate signal intensity on T1-weighted MR images. (b) Axial contrast material-enhanced MR image shows diffuse enhancement of the mass. Nonenhancement of a portion of the tumor (black arrow) is suggestive of necrosis. Note the thickening and enhancement of the medial wall of the left maxillary sinus (white arrow), an appearance suggestive of tumor infiltration. (c) Coronal contrast-enhanced MR image shows diffuse spread of the tumor in the left ethmoid sinus and left nasal cavity.

View larger version (97K): [in a new window]   Figure 3a.  Nasal-type extranodal NK/T-cell lymphoma involving the larynx and trachea in a 12-year-old girl. (a, b) Anteroposterior (a) and lateral (b) radiographs of the cervical spine show luminal irregularity with narrowing of the upper trachea (arrows). (c) CT scan shows diffuse thickening of the tracheal wall (black arrow). The air in the soft tissues on the right side of the neck (white arrows) originated from a tracheostomy.

View larger version (99K): [in a new window]   Figure 3b.  Nasal-type extranodal NK/T-cell lymphoma involving the larynx and trachea in a 12-year-old girl. (a, b) Anteroposterior (a) and lateral (b) radiographs of the cervical spine show luminal irregularity with narrowing of the upper trachea (arrows). (c) CT scan shows diffuse thickening of the tracheal wall (black arrow). The air in the soft tissues on the right side of the neck (white arrows) originated from a tracheostomy.

View larger version (143K): [in a new window]   Figure 3c.  Nasal-type extranodal NK/T-cell lymphoma involving the larynx and trachea in a 12-year-old girl. (a, b) Anteroposterior (a) and lateral (b) radiographs of the cervical spine show luminal irregularity with narrowing of the upper trachea (arrows). (c) CT scan shows diffuse thickening of the tracheal wall (black arrow). The air in the soft tissues on the right side of the neck (white arrows) originated from a tracheostomy.

View larger version (181K): [in a new window]   Figure 4.  Enteropathy-type T-cell lymphoma involving the colon in a 44-year-old man. Photomicrograph (original magnification, x200; H-E stain) of a colectomy specimen shows atypical lymphoid cells with abundant cytoplasm (arrowheads) and small inflammatory lymphocytes (arrows) mixed at the site of mucosal ulceration. The pathology report on the initial colonoscopic biopsy specimen concluded that the patient had chronic nonspecific colitis; the diagnosis was confirmed after colonic resection.

View larger version (131K): [in a new window]   Figure 5a.  Enteropathy-type T-cell lymphoma involving the colon in a 37-year-old man. (a) Image from a double-contrast barium enema study shows multiple aphthous ulcers (thin arrows) and segmental luminal narrowing (thick arrows) in the transverse colon. (b) Close-up radiograph of the splenic flexure shows multiple irregular ulcers (arrows). (c) Photograph from colonoscopy shows an aphthous ulcer in the transverse colon (arrow). After one cycle of chemotherapy, the patient experienced colonic perforation. Segmental resection of the transverse colon was performed. (d) Photograph of the pathologic specimen shows segmental luminal irregularity in the transverse colon (white arrows). Multiple aphthous ulcers (black arrows) and the perforation site (arrowhead) are also noted. Scale is in 5-mm intervals.

View larger version (154K): [in a new window]   Figure 5b.  Enteropathy-type T-cell lymphoma involving the colon in a 37-year-old man. (a) Image from a double-contrast barium enema study shows multiple aphthous ulcers (thin arrows) and segmental luminal narrowing (thick arrows) in the transverse colon. (b) Close-up radiograph of the splenic flexure shows multiple irregular ulcers (arrows). (c) Photograph from colonoscopy shows an aphthous ulcer in the transverse colon (arrow). After one cycle of chemotherapy, the patient experienced colonic perforation. Segmental resection of the transverse colon was performed. (d) Photograph of the pathologic specimen shows segmental luminal irregularity in the transverse colon (white arrows). Multiple aphthous ulcers (black arrows) and the perforation site (arrowhead) are also noted. Scale is in 5-mm intervals.

View larger version (124K): [in a new window]   Figure 5c.  Enteropathy-type T-cell lymphoma involving the colon in a 37-year-old man. (a) Image from a double-contrast barium enema study shows multiple aphthous ulcers (thin arrows) and segmental luminal narrowing (thick arrows) in the transverse colon. (b) Close-up radiograph of the splenic flexure shows multiple irregular ulcers (arrows). (c) Photograph from colonoscopy shows an aphthous ulcer in the transverse colon (arrow). After one cycle of chemotherapy, the patient experienced colonic perforation. Segmental resection of the transverse colon was performed. (d) Photograph of the pathologic specimen shows segmental luminal irregularity in the transverse colon (white arrows). Multiple aphthous ulcers (black arrows) and the perforation site (arrowhead) are also noted. Scale is in 5-mm intervals.

View larger version (77K): [in a new window]   Figure 5d.  Enteropathy-type T-cell lymphoma involving the colon in a 37-year-old man. (a) Image from a double-contrast barium enema study shows multiple aphthous ulcers (thin arrows) and segmental luminal narrowing (thick arrows) in the transverse colon. (b) Close-up radiograph of the splenic flexure shows multiple irregular ulcers (arrows). (c) Photograph from colonoscopy shows an aphthous ulcer in the transverse colon (arrow). After one cycle of chemotherapy, the patient experienced colonic perforation. Segmental resection of the transverse colon was performed. (d) Photograph of the pathologic specimen shows segmental luminal irregularity in the transverse colon (white arrows). Multiple aphthous ulcers (black arrows) and the perforation site (arrowhead) are also noted. Scale is in 5-mm intervals.

View larger version (133K): [in a new window]   Figure 6a.  Enteropathy-type T-cell lymphoma involving the terminal ileum in a 61-year-old man. (a) Image from a barium study of the small intestine shows a linear ulcer (arrows) along the mesenteric border in the terminal ileum. (b) Close-up radiograph of the terminal ileum shows a pseudosacculation (open arrows) along the antimesenteric border and a linear ulcer (solid arrows) along the mesenteric border in the terminal ileum. (c) CT scan shows wall thickening in the terminal ileum (arrow) and mesenteric fat infiltration around the ileum. (d) Photograph of the ileocecectomy specimen shows multiple irregular ulcers (arrows) in the terminal ileum. The prospective radiologic diagnosis was Crohn disease on the basis of the linear ulcers and pseudosacculation of the terminal ileum. Moreover, the pathologic diagnosis after the initial ileal biopsy was chronic nonspecific ileitis. The diagnosis was confirmed with surgical resection of the intestine. Scale is in 5-mm intervals.

View larger version (136K): [in a new window]   Figure 6b.  Enteropathy-type T-cell lymphoma involving the terminal ileum in a 61-year-old man. (a) Image from a barium study of the small intestine shows a linear ulcer (arrows) along the mesenteric border in the terminal ileum. (b) Close-up radiograph of the terminal ileum shows a pseudosacculation (open arrows) along the antimesenteric border and a linear ulcer (solid arrows) along the mesenteric border in the terminal ileum. (c) CT scan shows wall thickening in the terminal ileum (arrow) and mesenteric fat infiltration around the ileum. (d) Photograph of the ileocecectomy specimen shows multiple irregular ulcers (arrows) in the terminal ileum. The prospective radiologic diagnosis was Crohn disease on the basis of the linear ulcers and pseudosacculation of the terminal ileum. Moreover, the pathologic diagnosis after the initial ileal biopsy was chronic nonspecific ileitis. The diagnosis was confirmed with surgical resection of the intestine. Scale is in 5-mm intervals.

View larger version (120K): [in a new window]   Figure 6c.  Enteropathy-type T-cell lymphoma involving the terminal ileum in a 61-year-old man. (a) Image from a barium study of the small intestine shows a linear ulcer (arrows) along the mesenteric border in the terminal ileum. (b) Close-up radiograph of the terminal ileum shows a pseudosacculation (open arrows) along the antimesenteric border and a linear ulcer (solid arrows) along the mesenteric border in the terminal ileum. (c) CT scan shows wall thickening in the terminal ileum (arrow) and mesenteric fat infiltration around the ileum. (d) Photograph of the ileocecectomy specimen shows multiple irregular ulcers (arrows) in the terminal ileum. The prospective radiologic diagnosis was Crohn disease on the basis of the linear ulcers and pseudosacculation of the terminal ileum. Moreover, the pathologic diagnosis after the initial ileal biopsy was chronic nonspecific ileitis. The diagnosis was confirmed with surgical resection of the intestine. Scale is in 5-mm intervals.

View larger version (122K): [in a new window]   Figure 6d.  Enteropathy-type T-cell lymphoma involving the terminal ileum in a 61-year-old man. (a) Image from a barium study of the small intestine shows a linear ulcer (arrows) along the mesenteric border in the terminal ileum. (b) Close-up radiograph of the terminal ileum shows a pseudosacculation (open arrows) along the antimesenteric border and a linear ulcer (solid arrows) along the mesenteric border in the terminal ileum. (c) CT scan shows wall thickening in the terminal ileum (arrow) and mesenteric fat infiltration around the ileum. (d) Photograph of the ileocecectomy specimen shows multiple irregular ulcers (arrows) in the terminal ileum. The prospective radiologic diagnosis was Crohn disease on the basis of the linear ulcers and pseudosacculation of the terminal ileum. Moreover, the pathologic diagnosis after the initial ileal biopsy was chronic nonspecific ileitis. The diagnosis was confirmed with surgical resection of the intestine. Scale is in 5-mm intervals.

View larger version (107K): [in a new window]   Figure 7.  Mycosis fungoides in a 36-year-old woman. Photograph shows a cutaneous erythematous plaque (solid arrows) and a cutaneous tumor (open arrows). This appearance represents a typical gross morphology of mycosis fungoides.

View larger version (144K): [in a new window]   Figure 8.  Mycosis fungoides in a 63-year-old woman. Photomicrograph (original magnification, x200; H-E stain) of a skin biopsy specimen shows prominent epidermotropism of lymphocytes (arrows). Note the lack of striking nuclear atypia of the intraepidermal lymphocytes. D = dermis, E = epidermis.

View larger version (118K): [in a new window]   Figure 9a.  Mycosis fungoides in a 51-year-old man. (a) CT scan shows a large tumor (open arrows) in the anterior abdominal wall. The tumor involves the skin and subcutaneous fat. A small air bubble suggestive of an ulcer (solid arrow) is also noted. (b) Photograph shows an ulcerated cutaneous tumor (arrows). Superficial ulceration of a cutaneous tumor represents an atypical gross morphology of mycosis fungoides. (c) Sagittal contrast-enhanced MR image shows another mass on the medial side of the plantar surface (arrow). The mass demonstrates mild homogeneous enhancement. The mass had intermediate signal intensity on T2-weighted images and low signal intensity on T1-weighted images.

View larger version (105K): [in a new window]   Figure 9b.  Mycosis fungoides in a 51-year-old man. (a) CT scan shows a large tumor (open arrows) in the anterior abdominal wall. The tumor involves the skin and subcutaneous fat. A small air bubble suggestive of an ulcer (solid arrow) is also noted. (b) Photograph shows an ulcerated cutaneous tumor (arrows). Superficial ulceration of a cutaneous tumor represents an atypical gross morphology of mycosis fungoides. (c) Sagittal contrast-enhanced MR image shows another mass on the medial side of the plantar surface (arrow). The mass demonstrates mild homogeneous enhancement. The mass had intermediate signal intensity on T2-weighted images and low signal intensity on T1-weighted images.

View larger version (67K): [in a new window]   Figure 9c.  Mycosis fungoides in a 51-year-old man. (a) CT scan shows a large tumor (open arrows) in the anterior abdominal wall. The tumor involves the skin and subcutaneous fat. A small air bubble suggestive of an ulcer (solid arrow) is also noted. (b) Photograph shows an ulcerated cutaneous tumor (arrows). Superficial ulceration of a cutaneous tumor represents an atypical gross morphology of mycosis fungoides. (c) Sagittal contrast-enhanced MR image shows another mass on the medial side of the plantar surface (arrow). The mass demonstrates mild homogeneous enhancement. The mass had intermediate signal intensity on T2-weighted images and low signal intensity on T1-weighted images.

View larger version (150K): [in a new window]   Figure 10a.  Mycosis fungoides in a 52-year-old woman. (a) Axial T2-weighted MR image shows a large tumor (arrows) involving the right upper eyelid. The tumor has low signal intensity and involves the skin and subcutaneous tissue. (b) Axial T1-weighted MR image shows that the mass has intermediate signal intensity (arrows). (c) Axial MR image obtained after injection of gadopentetate dimeglumine shows that the mass has diffuse marked enhancement (arrows). (d) CT scan obtained at the level of the hypopharynx shows enlarged lymph nodes in the submental area (thin solid arrows), submandibular area (open arrows), retropharyngeal area (thick solid arrow), and right spinal accessory chain (arrowhead). Laryngeal edema and edematous infiltration into the subcutaneous fat are also seen. Biopsy of the tumor and lymph nodes was performed. Pathologic analysis demonstrated mycosis fungoides involving the skin, subcutaneous tissue, and lymph nodes. Therefore, the patient had stage IV disease (T3 N3).

View larger version (138K): [in a new window]   Figure 10b.  Mycosis fungoides in a 52-year-old woman. (a) Axial T2-weighted MR image shows a large tumor (arrows) involving the right upper eyelid. The tumor has low signal intensity and involves the skin and subcutaneous tissue. (b) Axial T1-weighted MR image shows that the mass has intermediate signal intensity (arrows). (c) Axial MR image obtained after injection of gadopentetate dimeglumine shows that the mass has diffuse marked enhancement (arrows). (d) CT scan obtained at the level of the hypopharynx shows enlarged lymph nodes in the submental area (thin solid arrows), submandibular area (open arrows), retropharyngeal area (thick solid arrow), and right spinal accessory chain (arrowhead). Laryngeal edema and edematous infiltration into the subcutaneous fat are also seen. Biopsy of the tumor and lymph nodes was performed. Pathologic analysis demonstrated mycosis fungoides involving the skin, subcutaneous tissue, and lymph nodes. Therefore, the patient had stage IV disease (T3 N3).

View larger version (142K): [in a new window]   Figure 10c.  Mycosis fungoides in a 52-year-old woman. (a) Axial T2-weighted MR image shows a large tumor (arrows) involving the right upper eyelid. The tumor has low signal intensity and involves the skin and subcutaneous tissue. (b) Axial T1-weighted MR image shows that the mass has intermediate signal intensity (arrows). (c) Axial MR image obtained after injection of gadopentetate dimeglumine shows that the mass has diffuse marked enhancement (arrows). (d) CT scan obtained at the level of the hypopharynx shows enlarged lymph nodes in the submental area (thin solid arrows), submandibular area (open arrows), retropharyngeal area (thick solid arrow), and right spinal accessory chain (arrowhead). Laryngeal edema and edematous infiltration into the subcutaneous fat are also seen. Biopsy of the tumor and lymph nodes was performed. Pathologic analysis demonstrated mycosis fungoides involving the skin, subcutaneous tissue, and lymph nodes. Therefore, the patient had stage IV disease (T3 N3).

View larger version (130K): [in a new window]   Figure 10d.  Mycosis fungoides in a 52-year-old woman. (a) Axial T2-weighted MR image shows a large tumor (arrows) involving the right upper eyelid. The tumor has low signal intensity and involves the skin and subcutaneous tissue. (b) Axial T1-weighted MR image shows that the mass has intermediate signal intensity (arrows). (c) Axial MR image obtained after injection of gadopentetate dimeglumine shows that the mass has diffuse marked enhancement (arrows). (d) CT scan obtained at the level of the hypopharynx shows enlarged lymph nodes in the submental area (thin solid arrows), submandibular area (open arrows), retropharyngeal area (thick solid arrow), and right spinal accessory chain (arrowhead). Laryngeal edema and edematous infiltration into the subcutaneous fat are also seen. Biopsy of the tumor and lymph nodes was performed. Pathologic analysis demonstrated mycosis fungoides involving the skin, subcutaneous tissue, and lymph nodes. Therefore, the patient had stage IV disease (T3 N3).

View larger version (168K): [in a new window]   Figure 11a.  Subcutaneous panniculitis-like T-cell lymphoma in a 12-year-old girl. (a) Photomicrograph (original magnification, x100; H-E stain) shows a lymphoid cell infiltrate in the subcutaneous fat layer. Lymphoid cells surround individual adipocytes (F). (b) Abdominal CT scan shows multiple nodules (arrows) in the subcutaneous fat. At gross examination, the subcutaneous nodules gave rise to superficial elevated lesions on the skin.

View larger version (103K): [in a new window]   Figure 11b.  Subcutaneous panniculitis-like T-cell lymphoma in a 12-year-old girl. (a) Photomicrograph (original magnification, x100; H-E stain) shows a lymphoid cell infiltrate in the subcutaneous fat layer. Lymphoid cells surround individual adipocytes (F). (b) Abdominal CT scan shows multiple nodules (arrows) in the subcutaneous fat. At gross examination, the subcutaneous nodules gave rise to superficial elevated lesions on the skin.

View larger version (207K): [in a new window]   Figure 12a.  Primary cutaneous type ALCL in a 63-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) of a skin biopsy specimen shows infiltration of atypical lymphoid cells with a perineural distribution into the dermis. N = nerve. (b) Photomicrograph (original magnification, x200; H-E stain) shows scattered large lymphoid cells (ie, anaplastic large cells) with pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm (arrows).

View larger version (188K): [in a new window]   Figure 12b.  Primary cutaneous type ALCL in a 63-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) of a skin biopsy specimen shows infiltration of atypical lymphoid cells with a perineural distribution into the dermis. N = nerve. (b) Photomicrograph (original magnification, x200; H-E stain) shows scattered large lymphoid cells (ie, anaplastic large cells) with pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm (arrows).

View larger version (135K): [in a new window]   Figure 13a.  Primary cutaneous type ALCL in a 61-year-old man. (a) Axial T2-weighted MR image shows a mass (arrows) in the right eyelid. The mass has intermediate signal intensity. (b) Axial T1-weighted MR image shows that the mass has homogeneous low signal intensity (arrows). (c) Axial fat-suppressed T1-weighted MR image obtained after administration of gadopentetate dimeglumine shows homogeneous enhancement of the mass (arrows). (d) Photograph shows a round elevated erythematous tumor involving the right lower eyelid. A central superficial ulcer and crust are noted; these represent the typical gross morphology of cutaneous ALCL.

View larger version (124K): [in a new window]   Figure 13b.  Primary cutaneous type ALCL in a 61-year-old man. (a) Axial T2-weighted MR image shows a mass (arrows) in the right eyelid. The mass has intermediate signal intensity. (b) Axial T1-weighted MR image shows that the mass has homogeneous low signal intensity (arrows). (c) Axial fat-suppressed T1-weighted MR image obtained after administration of gadopentetate dimeglumine shows homogeneous enhancement of the mass (arrows). (d) Photograph shows a round elevated erythematous tumor involving the right lower eyelid. A central superficial ulcer and crust are noted; these represent the typical gross morphology of cutaneous ALCL.

View larger version (120K): [in a new window]   Figure 13c.  Primary cutaneous type ALCL in a 61-year-old man. (a) Axial T2-weighted MR image shows a mass (arrows) in the right eyelid. The mass has intermediate signal intensity. (b) Axial T1-weighted MR image shows that the mass has homogeneous low signal intensity (arrows). (c) Axial fat-suppressed T1-weighted MR image obtained after administration of gadopentetate dimeglumine shows homogeneous enhancement of the mass (arrows). (d) Photograph shows a round elevated erythematous tumor involving the right lower eyelid. A central superficial ulcer and crust are noted; these represent the typical gross morphology of cutaneous ALCL.

View larger version (113K): [in a new window]   Figure 13d.  Primary cutaneous type ALCL in a 61-year-old man. (a) Axial T2-weighted MR image shows a mass (arrows) in the right eyelid. The mass has intermediate signal intensity. (b) Axial T1-weighted MR image shows that the mass has homogeneous low signal intensity (arrows). (c) Axial fat-suppressed T1-weighted MR image obtained after administration of gadopentetate dimeglumine shows homogeneous enhancement of the mass (arrows). (d) Photograph shows a round elevated erythematous tumor involving the right lower eyelid. A central superficial ulcer and crust are noted; these represent the typical gross morphology of cutaneous ALCL.

View larger version (169K): [in a new window]   Figure 14a.  Primary systemic type ALCL in a 12-year-old girl. (a) Photomicrograph (original magnification, x200; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of large lymphoid cells (arrows) with pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of Ki-1 antigen-labeled tissue shows atypical lymphoid cells that react positively and appear brown. (c) Anteroposterior chest radiograph shows disseminated nodules involving both lungs (open arrows). Right-sided paratracheal bulging suggestive of lymph node enlargement (solid arrows) and pleural effusions are also seen. (d) Chest CT scan (lung window) shows nodular consolidations containing air bronchograms in both lungs (arrows). (e) Chest CT scan shows conglomerated interlobar and peribronchial enlarged lymph nodes (arrows). Bilateral pleural effusions are also noted. (f) Abdominal CT scan shows multiple enlarged lymph nodes in the mesentery of the left gastric and gastrohepatic area (open arrows). Multiple enhancing nodules suggestive of pleural seeding (solid arrows) and bilateral pleural effusions are also noted.

View larger version (122K): [in a new window]   Figure 14b.  Primary systemic type ALCL in a 12-year-old girl. (a) Photomicrograph (original magnification, x200; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of large lymphoid cells (arrows) with pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of Ki-1 antigen-labeled tissue shows atypical lymphoid cells that react positively and appear brown. (c) Anteroposterior chest radiograph shows disseminated nodules involving both lungs (open arrows). Right-sided paratracheal bulging suggestive of lymph node enlargement (solid arrows) and pleural effusions are also seen. (d) Chest CT scan (lung window) shows nodular consolidations containing air bronchograms in both lungs (arrows). (e) Chest CT scan shows conglomerated interlobar and peribronchial enlarged lymph nodes (arrows). Bilateral pleural effusions are also noted. (f) Abdominal CT scan shows multiple enlarged lymph nodes in the mesentery of the left gastric and gastrohepatic area (open arrows). Multiple enhancing nodules suggestive of pleural seeding (solid arrows) and bilateral pleural effusions are also noted.

View larger version (111K): [in a new window]   Figure 14c.  Primary systemic type ALCL in a 12-year-old girl. (a) Photomicrograph (original magnification, x200; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of large lymphoid cells (arrows) with pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of Ki-1 antigen-labeled tissue shows atypical lymphoid cells that react positively and appear brown. (c) Anteroposterior chest radiograph shows disseminated nodules involving both lungs (open arrows). Right-sided paratracheal bulging suggestive of lymph node enlargement (solid arrows) and pleural effusions are also seen. (d) Chest CT scan (lung window) shows nodular consolidations containing air bronchograms in both lungs (arrows). (e) Chest CT scan shows conglomerated interlobar and peribronchial enlarged lymph nodes (arrows). Bilateral pleural effusions are also noted. (f) Abdominal CT scan shows multiple enlarged lymph nodes in the mesentery of the left gastric and gastrohepatic area (open arrows). Multiple enhancing nodules suggestive of pleural seeding (solid arrows) and bilateral pleural effusions are also noted.

View larger version (93K): [in a new window]   Figure 14d.  Primary systemic type ALCL in a 12-year-old girl. (a) Photomicrograph (original magnification, x200; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of large lymphoid cells (arrows) with pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of Ki-1 antigen-labeled tissue shows atypical lymphoid cells that react positively and appear brown. (c) Anteroposterior chest radiograph shows disseminated nodules involving both lungs (open arrows). Right-sided paratracheal bulging suggestive of lymph node enlargement (solid arrows) and pleural effusions are also seen. (d) Chest CT scan (lung window) shows nodular consolidations containing air bronchograms in both lungs (arrows). (e) Chest CT scan shows conglomerated interlobar and peribronchial enlarged lymph nodes (arrows). Bilateral pleural effusions are also noted. (f) Abdominal CT scan shows multiple enlarged lymph nodes in the mesentery of the left gastric and gastrohepatic area (open arrows). Multiple enhancing nodules suggestive of pleural seeding (solid arrows) and bilateral pleural effusions are also noted.

View larger version (118K): [in a new window]   Figure 14e.  Primary systemic type ALCL in a 12-year-old girl. (a) Photomicrograph (original magnification, x200; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of large lymphoid cells (arrows) with pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of Ki-1 antigen-labeled tissue shows atypical lymphoid cells that react positively and appear brown. (c) Anteroposterior chest radiograph shows disseminated nodules involving both lungs (open arrows). Right-sided paratracheal bulging suggestive of lymph node enlargement (solid arrows) and pleural effusions are also seen. (d) Chest CT scan (lung window) shows nodular consolidations containing air bronchograms in both lungs (arrows). (e) Chest CT scan shows conglomerated interlobar and peribronchial enlarged lymph nodes (arrows). Bilateral pleural effusions are also noted. (f) Abdominal CT scan shows multiple enlarged lymph nodes in the mesentery of the left gastric and gastrohepatic area (open arrows). Multiple enhancing nodules suggestive of pleural seeding (solid arrows) and bilateral pleural effusions are also noted.

View larger version (116K): [in a new window]   Figure 14f.  Primary systemic type ALCL in a 12-year-old girl. (a) Photomicrograph (original magnification, x200; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of large lymphoid cells (arrows) with pleomorphic nuclei, prominent nucleoli, and abundant cytoplasm. (b) Photomicrograph (original magnification, x200; immunohistochemical stain on paraffin-embedded material) of Ki-1 antigen-labeled tissue shows atypical lymphoid cells that react positively and appear brown. (c) Anteroposterior chest radiograph shows disseminated nodules involving both lungs (open arrows). Right-sided paratracheal bulging suggestive of lymph node enlargement (solid arrows) and pleural effusions are also seen. (d) Chest CT scan (lung window) shows nodular consolidations containing air bronchograms in both lungs (arrows). (e) Chest CT scan shows conglomerated interlobar and peribronchial enlarged lymph nodes (arrows). Bilateral pleural effusions are also noted. (f) Abdominal CT scan shows multiple enlarged lymph nodes in the mesentery of the left gastric and gastrohepatic area (open arrows). Multiple enhancing nodules suggestive of pleural seeding (solid arrows) and bilateral pleural effusions are also noted.

View larger version (200K): [in a new window]   Figure 15a.  Angioimmunoblastic T-cell lymphoma in an 18-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of lymphoid cells and prominent vascular proliferation (arrows). (b) High-power photomicrograph (original magnification, x200; H-E stain) shows lymphoid cells admixed with immunoblasts (arrowhead) and plasma cells (straight arrows). Vascular proliferation (curved arrow) is also noted. The term angioimmunoblastic in the name of this condition is due to the vascular proliferation and admixed immunoblasts. (c) Contrast-enhanced chest CT scan shows multiple enlarged lymph nodes (arrows) in the prevascular, right lower paratracheal, and axillary areas. Bilateral pleural effusions are also noted. (d) Abdominal CT scan shows enlargement of the liver and spleen. Multiple enlarged lymph nodes are seen in the hepatic hilum, splenic hilum, and retrocrural area (arrows). (e) CT scan shows multiple enlarged lymph nodes in the mesentery and retroperitoneal area (arrows) and ascites. Multiple enlarged mesenteric lymph nodes and mesenteric nodules are suggestive of mesenteric lymphomatosis.

View larger version (178K): [in a new window]   Figure 15b.  Angioimmunoblastic T-cell lymphoma in an 18-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of lymphoid cells and prominent vascular proliferation (arrows). (b) High-power photomicrograph (original magnification, x200; H-E stain) shows lymphoid cells admixed with immunoblasts (arrowhead) and plasma cells (straight arrows). Vascular proliferation (curved arrow) is also noted. The term angioimmunoblastic in the name of this condition is due to the vascular proliferation and admixed immunoblasts. (c) Contrast-enhanced chest CT scan shows multiple enlarged lymph nodes (arrows) in the prevascular, right lower paratracheal, and axillary areas. Bilateral pleural effusions are also noted. (d) Abdominal CT scan shows enlargement of the liver and spleen. Multiple enlarged lymph nodes are seen in the hepatic hilum, splenic hilum, and retrocrural area (arrows). (e) CT scan shows multiple enlarged lymph nodes in the mesentery and retroperitoneal area (arrows) and ascites. Multiple enlarged mesenteric lymph nodes and mesenteric nodules are suggestive of mesenteric lymphomatosis.

View larger version (117K): [in a new window]   Figure 15c.  Angioimmunoblastic T-cell lymphoma in an 18-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of lymphoid cells and prominent vascular proliferation (arrows). (b) High-power photomicrograph (original magnification, x200; H-E stain) shows lymphoid cells admixed with immunoblasts (arrowhead) and plasma cells (straight arrows). Vascular proliferation (curved arrow) is also noted. The term angioimmunoblastic in the name of this condition is due to the vascular proliferation and admixed immunoblasts. (c) Contrast-enhanced chest CT scan shows multiple enlarged lymph nodes (arrows) in the prevascular, right lower paratracheal, and axillary areas. Bilateral pleural effusions are also noted. (d) Abdominal CT scan shows enlargement of the liver and spleen. Multiple enlarged lymph nodes are seen in the hepatic hilum, splenic hilum, and retrocrural area (arrows). (e) CT scan shows multiple enlarged lymph nodes in the mesentery and retroperitoneal area (arrows) and ascites. Multiple enlarged mesenteric lymph nodes and mesenteric nodules are suggestive of mesenteric lymphomatosis.

View larger version (119K): [in a new window]   Figure 15d.  Angioimmunoblastic T-cell lymphoma in an 18-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of lymphoid cells and prominent vascular proliferation (arrows). (b) High-power photomicrograph (original magnification, x200; H-E stain) shows lymphoid cells admixed with immunoblasts (arrowhead) and plasma cells (straight arrows). Vascular proliferation (curved arrow) is also noted. The term angioimmunoblastic in the name of this condition is due to the vascular proliferation and admixed immunoblasts. (c) Contrast-enhanced chest CT scan shows multiple enlarged lymph nodes (arrows) in the prevascular, right lower paratracheal, and axillary areas. Bilateral pleural effusions are also noted. (d) Abdominal CT scan shows enlargement of the liver and spleen. Multiple enlarged lymph nodes are seen in the hepatic hilum, splenic hilum, and retrocrural area (arrows). (e) CT scan shows multiple enlarged lymph nodes in the mesentery and retroperitoneal area (arrows) and ascites. Multiple enlarged mesenteric lymph nodes and mesenteric nodules are suggestive of mesenteric lymphomatosis.

View larger version (123K): [in a new window]   Figure 15e.  Angioimmunoblastic T-cell lymphoma in an 18-year-old woman. (a) Photomicrograph (original magnification, x100; H-E stain) of a cervical lymph node biopsy specimen shows diffuse proliferation of lymphoid cells and prominent vascular proliferation (arrows). (b) High-power photomicrograph (original magnification, x200; H-E stain) shows lymphoid cells admixed with immunoblasts (arrowhead) and plasma cells (straight arrows). Vascular proliferation (curved arrow) is also noted. The term angioimmunoblastic in the name of this condition is due to the vascular proliferation and admixed immunoblasts. (c) Contrast-enhanced chest CT scan shows multiple enlarged lymph nodes (arrows) in the prevascular, right lower paratracheal, and axillary areas. Bilateral pleural effusions are also noted. (d) Abdominal CT scan shows enlargement of the liver and spleen. Multiple enlarged lymph nodes are seen in the hepatic hilum, splenic hilum, and retrocrural area (arrows). (e) CT scan shows multiple enlarged lymph nodes in the mesentery and retroperitoneal area (arrows) and ascites. Multiple enlarged mesenteric lymph nodes and mesenteric nodules are suggestive of mesenteric lymphomatosis.