case_images: PMC10691828_01
case_images: a A CT-TAP taken on December 18, 2018 showing a 2.4 cm rounded ground-glass pulmonary opacity in the middle lobe of the right lung. b A CT thorax taken in July 2019 showing the GGO is stable and measures approximately 2.5 cm. c, d PET-CT whole body taken in September 2019 showing the lesion in the right lung to have increased in size from 16 x 17 x 22 mm to 19 x 28 x 17 mm, displaying low level FDG uptake (maximum SUV 2.6).
case_images: cro-2023-0016-0001-534802_F01.jpg
case_images: PMC10691828_01_cro-2023-0016-0001-534802_F01.jpg
case_images: F1
case_images: As part of the investigations for the UTI, a CT thorax abdomen pelvis was performed which revealed a 2.4 cm rounded pulmonary ground glass opacity (GGO) in the right middle lobe (Fig. 1a). April 30, 2019 with the last cycle being administered on the 21st of May. A repeat CT thorax was done in July that same year and the GGO was found to be stable in size (Fig. 1b). During a follow-up positron emission tomography (PET)-CT scan in September 2019, the GGO was found to have increased slightly in size from 16 x 17 x 22 mm to 19 x 28 x 17 mm with low level FDG uptake and a maximum SUV of 2.6 (Fig. 1d), however no new pulmonary or pleural lesions were identified (Fig. 1c).
case_images: a Lung core biopsy showing a dense chronic inflammatory infiltrate (H&E, x25). b Infiltrate composed of lymphocytes and plasma cells (H&E, x100). c Kappa immunoglobulin light chain immunohistochemistry. d Lambda immunoglobulin light chain immunohistochemistry.
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case_images: PMC10691828_01_cro-2023-0016-0001-534802_F02.jpg
case_images: F2
case_images: In January of 2019, the patient underwent a CT-guided core biopsy of the lung which demonstrated a dense chronic inflammatory infiltrate, including lymphocytes and plasma cells (Fig. 2a, b). Definitive light chain restriction was not demonstrated by immunohistochemistry but multiplex PCR confirmed a clonal B cell population (clonal immunoglobulin heavy chain gene rearrangements VFR1-J, VFR2-J, and VFR3-J) (Fig. 2c, d).
case_images: Repeat CT thorax abdomen pelvis performed on May 12, 2021. Showing the previously noted mass in the right upper lobe had reduced in size and density compared with prior studies. With the maximal axial dimension having reduced from 24 mm to 15 mm at the corresponding level.
case_images: cro-2023-0016-0001-534802_F03.jpg
case_images: PMC10691828_01_cro-2023-0016-0001-534802_F03.jpg
case_images: F3
case_images: The radiological abnormality in the treatment site has remained stable, as seen in a follow-up CT-TAP performed in May 2021, with maximal axial dimensions having reduced from 24 mm to 15 mm at the corresponding level (Fig. 3).