PMC5519473_01
(A) Chest CT before irinotecan in May 2014, (B) chest high-resolution CT (HRCT) at the end of the second cycle of irinotecan in late July 2014, when the respiratory symptoms and ground-glass shadow appeared, and (C) HRCT in late August 2014, one month after introduction of steroid therapy.
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Computed tomography (CT) showed diffuse ground-glass shadow spreading in all of the lung fields, in addition to shrinkage of the lung metastases (Fig. 1). CT in late August 2014 showed disappearance of the ground-glass shadows (Fig. 1).
The broncho-alveolar lavage fluid gradually became bloody from the left tube to the right tube.
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Bronchoalveolar lavage fluid (BALF) recovered from B4 in the right middle lobe, with a recovery rate of 40% (60 mL/150 mL of saline), gradually became bloody (Fig. 2).
Hemosiderin-laden macrophages with positive staining of iron (Berlin blue) in the bronchoalveolar lavage fluid.
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BALF indicated the following: alveolar macrophages 58%, neutrophils 3%, lymphocytes 38% and eosinophils 1%. BALF contained macrophages with positive staining of iron (Berlin blue) but no atypical cells suspected of malignancy (Fig. 3).