case_images: PMC4608167_01
case_images: Thoracic computed tomography showing subpleural spiculated nodules.
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case_images: Staging exams included pelvic MRI, abdominal and thoracic computed tomography (CT), the later revealing two spiculated irregular lung nodules (Figure 1), establishing the diagnosis of a T3 N0 M1 (lung), stage IV vulvar carcinoma.
case_images: Photomicrography of the pulmonary nodule biopsy. A - Presence of granulomas with giant cells (HE, X); B - Presence of acid- fast bacilli small arrows, in detail in the inset (Ziehl-Neelsen, 1000X).
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case_images: Thus, two nodules were biopsied, revealing the presence of chronic inflammatory reaction with granulomas (Figure 2A) and the Ziehl-Neelsen staining was positive for mycobacteria, consistent with the diagnosis of pulmonary tuberculosis (Figure 2B).
case_images: PMC4608167_02
case_images: Thoracic computed tomography showing multiple bilateral scattered pulmonary nodules, some of them confluents and spiculated.
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case_images: Staging CTs revealed bilateral pulmonary nodules (1,5cm), raising the suspicion of metastatic disease (Figure 3).
case_images: Photomicrography of the lung biopsy showing chronic granulomatous inflammatory process.
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case_images: Lung biopsies (2 nodules) were performed, revealing chronic inflammatory granulomatous reaction with caseous necrosis (Figure 4).