case_images: PMC9960853_01
case_images: CXR and chest CT images on admission and after admission.. CXR on admission showed diffuse ground-glass opacities in both lungs (A). After discharge from the hospital, CXR showed new infiltrative shadows in addition to diffuse ground-glass opacities in both lungs (B). Chest CT on admission showed diffuse ground-glass opacities in both lungs with thickening of the interlobular septal wall (red arrow) (D). The chest CT showed new infiltrative shadows in addition to diffuse ground-glass opacities in both lungs (red arrowhead) (E). CXR and chest CT before VATS lung biopsy showed further exacerbation of the previous imaging findings (C, F). Contrast-enhanced CT of the abdomen on admission, showing hepatosplenomegaly (G) and bilateral kidney enlargement (H).
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case_images: FIG1
case_images: Chest radiography (CXR) revealed ground-glass opacities in both lung fields (Figure 1A). Chest computed tomography (CT) revealed diffuse ground-glass opacities with interlobular septal thickening (Figure 1D). Mild hepatosplenomegaly and bilateral kidney enlargement were also observed (Figures 1G, 1H). The CXR and CT scans, in addition to diffuse ground-glass opacities, also showed the appearance of mass-like infiltrates with moderate pleural effusion in both lungs (Figures 1B, 1E).
case_images: Pulmonary pathology by TBB.. Pulmonary pathology by TBB showed infiltration of lymphocytes and plasma cells in the interstitium. Some slightly enlarged lymphocyte-like cells were seen, but it was difficult to distinguish them from lymphoma (C HE staining, original magnification, x400).
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case_images: FIG2
case_images: TBB showed lymphocyte infiltration, but no non-caseating epithelioid cell granulomas were seen in sarcoidosis (Figure 2).
case_images: Renal biopsy tissue.. Lymphocytic infiltrate was observed in the interstitium (B HE staining, original magnification, x400).
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case_images: FIG3
case_images: The pathological diagnosis was interstitial nephritis (Figure 3).
case_images: Lung tissue biopsied by VATS.
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case_images: FIG4
case_images: These examinations were performed using integrated analysis of malignant lymphoma, ML-NET (Figures 4, 5).
case_images: Lung tissue sectioning by a pathologist to differentiate primary pulmonary malignant lymphoma.
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case_images: FIG5
case_images: These examinations were performed using integrated analysis of malignant lymphoma, ML-NET (Figures 4, 5).
case_images: VATS lung biopsy tissue.. Infiltration of lymphocytes and plasma cells was observed in the interstitium. Some slightly enlarged lymphocyte-like cells were seen (HE staining, original magnification, x400).
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case_images: FIG6
case_images: Hematoxylin-eosin staining showed an increase in medium-sized lymphocytes and slightly larger lymphocyte-like cells (Figure 6).
case_images: CD56 immunostaining in VATS lung biopsy tissue. . Immunostaining in VATS lung biopsy tissue showed medium-sized lymphocytes were partially CD56 positive (original magnification, x400).
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case_images: FIG7
case_images: Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).
case_images: CD8 immunostaining in VATS lung biopsy tissue.. Immunostaining in VATS lung biopsy tissue showed medium-sized lymphocytes were partially CD8 positive (original magnification, x400).
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case_images: FIG8
case_images: Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).
case_images: TIA-1 immunostaining in VATS lung biopsy tissue.. Immunostaining in VATS lung biopsy tissue showed medium-sized lymphocytes were TIA-1 positive (original magnification, x400).
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case_images: FIG9
case_images: Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).
case_images: GranzymeB immunostaining in VATS lung biopsy tissue.. Immunostaining in VATS lung biopsy tissue showed medium-sized lymphocytes were granzymeB positive (original magnification, x400).
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case_images: FIG10
case_images: Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).
case_images: EBV-encoded RNA ISH in VATS lung biopsy tissue.. Immunostaining in VATS lung biopsy tissue showed EBV-encoded RNA ISH positive (original magnification, x400).
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case_images: FIG11
case_images: Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).