case_images: PMC4531570_01
case_images: A plain chest radiograph (A) and a computerized tomograph (B, C) of case 1, revealing multiple, variably sized nodular lesions in both upper lung fields. Multiple mediastinal lymphadenopathies are also shown in the right lobe paratracheal and subcarinal areas. Microscopic findings of a transthoracic lung biopsy show irregular thickening of the alveolar septa and perivascular connective tissue, due to the diffuse infiltration of atypical lymphoid cells, which were confirmed as being of B-cell lineage by immunohistochemical staining (D, x 100 & x 200, H-E).
case_images: kjim-19-4-276-12f1.jpg
case_images: PMC4531570_01_kjim-19-4-276-12f1.jpg
case_images: f1-kjim-19-4-276-12
case_images: The other findings were unremarkable (Figure 1A-1C). The EBV-DNA reaction was positive by in situ hybridization, but light chain restriction could not be confirmed (Figure 1D).
case_images: PMC4531570_02
case_images: Radiograph of case 2 showing multiple air spaced nodules, which had speculated margins accompanied by peripheral ground glass opacity at the left upper lobe, with collapse of the lingular segment. The native right lung shows severe emphysematous changes (A, B, C). A percutaneous transthoracic needle biopsy specimen shows aggregation of lymphocytes, and an immunohistochemical study of these revealed a positive reaction to L-26, but negative reactions to UCHL-1, Kappa, Lambda, cytokeratin and Ki-1, suggesting a malignant lymphoma, which was later confirmed as a high grade B-cell type malignant lymphoma (D, x 100 & x 200, H-E).
case_images: kjim-19-4-276-12f2.jpg
case_images: PMC4531570_02_kjim-19-4-276-12f2.jpg
case_images: f2-kjim-19-4-276-12
case_images: These nodules had speculated margins with accompanying peripheral ground glass opacity, suggesting inflammatory changes (Figure 2A-2C). A malignant lymphoma, of high-grade large B-cell type, was confirmed (Figure 2D).