PMC4904552_01
(a) Axial CT scan of the chest with lung window settings at the level of the upper trachea demonstrates multiple bilateral thin-walled cysts and a few ill-defined centrilobular nodules (white arrows). Note a small left pneumothorax (thin black arrow). (b) Axial CT scan of the chest with lung window settings demonstrates bilateral thin-walled cysts, some with bizarre shapes such as in the left lower lobe. Note a small residual right-sided pneumothorax (arrow). (c) Coronal CT reformats with lung window settings demonstrate bilateral lung cysts, some with bizarre shapes (arrow) involving mainly the mid and upper lung zones with relative sparing of the costophrenic angles.
CRJ2016-3740902.001.jpg
PMC4904552_01_CRJ2016-3740902.001.jpg
fig1
There were a few ill-defined centrilobular nodules and no consolidation, pleural effusions, or lymph node enlargement (Figures 1(a), 1(b), and 1(c)).
(a) The wedge lung biopsy shows cellular nodules (thick arrows) and an irregular fibrous scar (arrowheads) delimiting a cystically dilated airspace (*). Note the flimsy adhesions on the pleural surface, secondary to the pneumothorax (right upper corner, thin arrows):hematoxylin and eosin stain, 11x. (b) Higher magnification of a cellular nodule reveals numerous histiocytes with folded nuclei (arrows) in an eosinophilic inflammatory background (arrowheads depicting eosinophils):hematoxylin and eosin stain, 400x. The inset shows strong expression of the immunohistochemical marker CD1a by the histiocytes (brown staining):CD1a immunohistochemical stain, 110x.
CRJ2016-3740902.002.jpg
PMC4904552_01_CRJ2016-3740902.002.jpg
fig2
In fact, a previous bullectomy specimen showed histological features consistent with PLCH (Figures 2(a) and 2(b)).
(a) Sagittal T1-weighted MRI of the sella turcica showing a thick pituitary stalk (arrow). Please note the absence of expected hyperintense (bright) signal of the neurohypophysis. (b) Coronal T1-weighted post-Gd MRI showing a thick pituitary stalk (arrow).
CRJ2016-3740902.003.jpg
PMC4904552_01_CRJ2016-3740902.003.jpg
fig3
Given his history of polydipsia, he underwent a brain MRI which showed focal nodular thickening with enhancement of the infundibulum with otherwise normal size of the pituitary gland; findings were found to be consistent with posterior pituitary involvement (Figures 3(a) and 3(b)).