case_images: PMC10797206_01
case_images: Chest X-rays of the patient. (A) Image at first visit to our hospital showed bilateral multiple tumorous and nodular shadows. (B) Image obtained 3 months after first visit showed improvement of opacities in the right lower lung field, and nodular shadows were partly enlarged in the left lung. (C) Image at 7 months after first visit showed extensive consolidation and enlargement of tumorous shadow in the left lung field. Nodular shadows were also present in the right hilum and the middle right lung field.
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case_images: A chest radiograph showed consolidation and tumorous shadow mainly in the lower bilateral lung fields (Fig. 1A). Because her symptoms and lung opacities improved spontaneously after her discharge (Figs. 1B and 2B), and decreased lymphocytes and immunoglobulin were shown, we decided to observe her condition without administration of medication. A chest radiograph showed extensive consolidation and enlargement of a tumorous shadow in the left lung field (Fig. 1C).
case_images: Chest CT images of the patient. (A) Image at first visit to our hospital showed multiple tumors and nodules in the bilateral lung fields. (B) Image at 4 months after first visit showed shrinking of tumors in the bilateral lower lobes and an enlarged nodule in the left lung. (C) Image at 7 months after first visit showed nodules were enlarged mainly in the left lung and a tumorous shadow emerged in the right lower lobe.
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case_images: Chest computed tomography (CT) showed multiple nodules mainly in the bilateral lower lung fields, some of which were fused and formed tumorous shadow or consolidation (Fig. 2A). Because her symptoms and lung opacities improved spontaneously after her discharge (Figs. 1B and 2B), and decreased lymphocytes and immunoglobulin were shown, we decided to observe her condition without administration of medication. CT showed enlargement of nodules mainly in the left lung field (Fig. 2C) and multiple lymphadenopathies from neck to abdomen.
case_images: Pathological features of the right cervical lymph node. (A) HE staining revealed high endothelial venules (HEV) with thickened walls showing irregular dendritic branching and pale/clear cells increased around the HEV. Immunohistochemical staining revealed the atypical cells to be positive for CD3 (B), a marker of matured T cells, and CD10 (C), a marker of follicular helper T cells, and negative for CD20 (D), a marker of B cells.
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case_images: A biopsy of her right cervical lymph node (Fig. 3) revealed high endothelial venules (HEV) with thickened walls showing irregular dendritic branching and increased pale/clear cells around the HEV.
case_images: Pathological features of lung tissues from the surgical lung biopsy. (A) Panoramic image of HE staining showed a well-circumscribed nodular lesion. HE staining x 20 (B) and x 60 magnification (C) showed HEV and pale/clear cells similar to findings of the cervical lymph node.
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case_images: We also performed surgical lung biopsy in the left upper lung, which showed similar findings to the biopsy of the right cervical lymph node (Fig. 4).