case_images: PMC5760873_01
case_images: (a) Computed tomography scan image showing endobronchial mass with collapse-consolidation of left lung with mediastinal shift, (b) chest X-ray image showing complete white-out of left lung
case_images: LI-35-66-g001.jpg
case_images: PMC5760873_01_LI-35-66-g001.jpg
case_images: F1
case_images: A chest X-ray [Figure 1] showed a complete white-out of the left lung with ipsilateral mediastinal shift suggesting complete lung collapse. A contrast-enhanced computed tomography of the thorax showed an endobronchial lesion in the left main bronchus with complete collapse-consolidation of the left lung; it also showed an endobronchial lesion in the right lower lobe [Figure 1].
case_images: Bronchoscopic images of tumor, (a) the left main bronchial tumor completely obstructing the left main bronchus, (b) the right lower lobe endobronchial tumor almost completely obstructing the right bronchus intermedius
case_images: LI-35-66-g002.jpg
case_images: PMC5760873_01_LI-35-66-g002.jpg
case_images: F2
case_images: He underwent a fibreoptic bronchoscopy which confirmed a left main bronchial growth and a right lower lobar bronchial growth and a guided biopsy of these endobronchial lesions [Figure 2] was done.
case_images: Histopathological examination revealed population of highly pleomorphic malignant cells arranged in diffuse sheets (a: H&E-400X). These tumor cells were immunopositive for CD30 (membranous positivity)(b: DAB;200x) and ALK-1(nuclear as well as cytoplasmic positivity) (c: DAB;400x) while negative for AE1/AE3 (d: DAB;200x) confirming the diagnosis of Alk-positive Anaplastic large cell lymphoma
case_images: LI-35-66-g003.jpg
case_images: PMC5760873_01_LI-35-66-g003.jpg
case_images: F3
case_images: Few cells showed wreath like/horseshoe-shaped nuclei [Figure 3a]. On immunohistochemistry (IHC) the tumor cells were strongly and diffusely positive for leukocyte common antigen, while negative for cytokeratin [Figure 3d], desmin and CD3 and CD20. On additional IHC the tumor revealed strong positivity for CD30[Figure 3b] and anaplastic lymphoma kinase-1 (ALK-1)[Figure 3c].
case_images: Chest X-ray showing complete expansion of previously collapsed left lung after starting chemotherapy
case_images: LI-35-66-g004.jpg
case_images: PMC5760873_01_LI-35-66-g004.jpg
case_images: F4
case_images: His chest X-ray which had shown complete collapse before treatment also showed dramatic improvement [Figure 4].