PMC6062774_01
(a) Computed tomography scan of chest showing a 1.7 x 1.1 cm right upper lobe cavitary nodule. (b) Positron-emission tomography scan showing extensive lymphadenopathy both above and below the diaphragm but no uptake in the right upper lobe cavitary lesion.
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Subsequently, a computed tomography (CT) scan of her chest, abdomen, and pelvis was performed that revealed extensive bilateral lymphadenopathy (above and below the diaphragm) as well as a new right upper lobe (RUL) thin-walled cavitary lung lesion with spiculated margins (Figure 1a). A positron-emission tomography (PET)-CT scan showed highly metabolically active lymphadenopathy in the neck, chest, abdomen, and pelvis but minimal to no PET avidity within the RUL cavitary lesion (Figure 1b). Chest CT was significant for severe emphysema, multiple indeterminate pulmonary nodules, and a 1.7 x 1.1 cm, subpleural, thin-walled cavitary lesion with spiculated margins in the RUL (Figure 1a).
(a) Histopathological examination revealed an infiltrating lepidic predominant adenocarcinoma (white arrow) with coexistent foci of lymphoid infiltrate (black arrow). (b) High-power examination revealed small, irregular, convoluted lymphocytes comprising the lymphoid infiltrate (black arrow). Adenocarcinoma cells (white arrow) show atypical, large nuclei with prominent nucleoli (hematoxylin and eosin). (c) Immunohistochemistry showing strong positivity for thyroid transcription factor-1.
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T1a), with coexistent foci of lymphoid infiltrates within and adjacent to adenocarcinoma (Figure 2a). The lymphoid infiltrate had histological features (convoluted irregular small nuclei; Figure 2b). By immunohistochemistry, the adenocarcinoma component was strongly positive with thyroid transcription factor-1, confirming pulmonary origin (Figure 2c) and discounting the possibility of metastasis from a possible mammary carcinoma.
Immunohistochemistry revealed lymphocytes showing strong and diffuse positivity for (a) generic B-cell marker CD20 and (b) mantle cell lymphoma (MCL) marker cyclin D1.
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