case_images: PMC11829542_01
case_images: Serial computed tomography scans showing progressive resolution of the diffuse micronodular interstitial pattern of the lungs following initiation of antiretroviral therapy on 16 November 2022 (A: 26 November 2021; B: 22 September 2022; C: 30 January 2023; D: 30 May 2024)
case_images: 12981_2025_717_Fig1_HTML.jpg
case_images: PMC11829542_01_12981_2025_717_Fig1_HTML.jpg
case_images: Fig1
case_images: In addition, small subpleural nodules with areas of ground glass opacities and enlarged mediastinal lymph nodes were documented (max diameter 2 cm, Fig. 1A). A new CT scan was subsequently performed in February 2022 (Fig. 1B). CT scan showed a clear regression of the lung lesions (Fig. 1C). Considering the rapid clinical and radiological improvement, we decided to withhold immunochemotherapy. These results were confirmed in May 2024 (Fig. 1D), thus achieving a complete and sustained clinical and radiological remission with the sole antiretroviral therapy.
case_images: Representative histopathological images of the surgical lung biopsy material. Light microscopy examination showed perivascular aggregates of lymphoplasmacytic elements (A-C), with focal angioinvasion (delimited by the arrows in B). Scattered lymphoid follicles were noted, with CD10+/BCL2- germinal centers (arrows in D and E, respectively) and Cyclin D1- mantle zones (delimited by the arrows in F). An abundant T-cell population (CD3+) was also present (G). This florid cellular infiltrate contained medium to large-sized atypical lymphoid elements, which were found to be CD20+ (H, arrows) / CD30+ (I, arrows) / PAX-5+ (J, arrow) / CD15- (K, arrow) / EBER+ (L, arrow). EBER, Epstein-Barr virus - Encoded small RNAs. H&E, Hematoxylin&Eosin
case_images: 12981_2025_717_Fig2_HTML.jpg
case_images: PMC11829542_01_12981_2025_717_Fig2_HTML.jpg
case_images: Fig2
case_images: Histological examination showed a lymphoplasmacytic infiltrate organized in perivascular aggregates with focal angioinvasion (Fig. 2A-C). Occasional lymphoid follicles were noted which contained a CD23+ dendritic cell meshwork, polarized germinal centers (CD10+/BCL2-) (Fig. 2D-E), and Cyclin D1- mantle zones (Fig. 2F). Immunohistochemical staining for the CD3 marker showed an abundant population of T lymphocytes throughout the interstitial infiltrate and in the regions surrounding the lymphoid follicles (Fig. 2G). Notably, the interstitial infiltrate contained up to 4-5 atypical lymphoid elements of intermediate/large size per high-power field (HPF), which were found to be CD20+, CD30+, PAX5+, CD15-, ALK-, and EBER+ (Fig. 2H-L).