PMC9622786_01
Chest computed tomography at different time periods. (A-C) Changes of ground-glass opacities, patchy shadows, and multiple nodules in both lungs within 50 days. (D, E) Changes of masses in the upper lobe of the left lung within 20 days. (The straight line indicates the left interlobar fissure). (G, H) Changes of the masses in the lower lobe of the left lung within 20 days. (The straight line indicates the interlobar fissure). (F, I) Imaging findings after 2 courses of chemotherapy.
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Chest computed tomography (CT) revealed ground-glass opacities, patchy shadows, and multiple nodules in both lungs and enlarged mediastinal lymph nodes ( Figure 1A ). Another chest CT showed decreased patchy shadows and multiple nodules in both lungs ( Figures 1B, C ). CT scan showed an increase of the masses in the left lung compared with previous findings ( Figures 1D, G ). CT-guided percutaneous lung biopsy was conducted on October 28, 2020. C), and was readmitted. CT revealed a reduction in the size of the masses in the upper lobe of the left lung (  Figure 1E  ) and an increase in the size of the masses in the lower lobe of the left lung compared with the previous scan ( Figure 1H ). Her clinical manifestations improved, and chest CT scan revealed a reduction of the multiple nodules and masses in both lungs after 2 courses of chemotherapy ( Figures 1F, I ).
Histology and immunohistochemistry of the core biopsy from the lung is consistent with lymphomatoid granulomatosis grade 3. (A) Proliferation and vascular infiltration of polymorphic lymphoid cells (x200 magnification). (B) Admixed T cells were positive for CD3 (x200 magnification). (C) Scattered CD20 positive large B-cells are detected-with arrows on the picture (x400 magnification). (D) The large cells are strongly stained with Pax5 (x400 magnification). (E) The large cells are positive for Ki-67 (x400 magnification). (F) The number of EBER positive cells is above 50/HPF consistent with garde 3 lymphomatoid granulomatosis (x400 magnification).
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Histopathological examination of the biopsied lung tissue showed proliferation and vascular infiltration of polymorphic lymphoid cells ( Figure 2 ).
(A-C) High FDG uptake at the dorsal segment of the left lower lobe (A) PET image, (B) CT mediastinal window, (C) PET and CT fusion images. (D-F) High FDG uptake at the posterior basal segment and lateral basal segments of the left lower lobe (D) PET image, (E) CT mediastinal window, (F) PET and CT fusion images. (G-I) No FDG uptake was observed in the mediastinal lymph nodes as shown within the circle (G) PET image, (H) CT mediastinal window, (I) PET and CT fusion images. (J) Except for the left lung tumor, there was no obviously high metabolism in other parts of the body.
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F-fludeoxyglucose (FDG) increased uptake in the dorsal segment, posterior basal segment, and lateral basal segment of the left lower lobe ( Figure 3 ). FDG uptake was not detected in the mediastinal lymph nodes, thus excluding secondary lung infiltration of nodal/mediastinal DLBCL ( Figures 3G   -I ).