PMC4821249_01
Chest X-ray showed consolidation on left lower lung fields, especially retrocardiac space.
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CRP 1.66 mg/dL. Chest radiography showed LLL consolidation, particularly retrocardiac space (Fig. 1).
After two weeks treatment, chest CT showed mass like consolidation on left lower lobe with pleural effusion, especially left dominant.
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He underwent chest computed tomography (CT), which showed consolidation at LLL and dominant left pleural effusion (Fig. 2).
Bronchoscopic finding showed reddish mucosal nodular lesions with edematous mucosa on superior segmental bronchus of left lower lobe.
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Bronchoscopic findings showed reddish mucosal nodular lesions with edematous mucosa on superior segmental bronchus of the left lower lobe (Fig. 3).
Pathologic findings of bronchoscopic biopsy. (A) Atypical medium-sized cells with irregular nuclei, inconspicuous nucleoli, high nuclear cytoplasmic ratio, and many apoptotic bodies. The atypical cells also showed an angiocentric growth pattern (H&E staining, X400). (B) Immunohistochemical stains showed positive reactivity for CD3 (X400). (C) Immunohistochemical stains showed positive CD56 (X400). (D) Immunohistochemical stains showed negative CD20 (X400). (E) In situ hybridization for Epstein-Barr virus-encoded RNA showed positive reaction in atypical cells (X400).
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Angiocentric growth pattern and coagulative necrosis were also observed (Fig. 4A). On immunohistochemical staining, the atypical cells were positive for CD3, CD30, CD56, MUM-1, and granzyme B but negative for cytokeratin, CD10, CD20, bcl-2, bcl-6, and ALK (Fig. 4B-D). In in situ hybridization for Epstein-Barr virus (EBV) encoded RNA (EBER), most atypical cells were labeled (Fig. 4E).