PMC6721390_01
CT chest with contrast showing bilateral interlobular septal thickening, multiple ground-glass opacities, and cystic changes.
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fig1
He had a repeat CT chest with contrast after 20 months concerning his progressively worsening weight loss and smoking history which showed 1.4 cm right lower lobe lung nodule, bilateral interlobular septal thickening with lower lobe predominance, multiple bilateral ground-glass opacities, cystic changes, and multiple enlarged mediastinal lymph nodes (Figures 1 and 2).
CT chest with contrast showing 1.4 cm right lower lobe lung nodule.
CRIRH2019-7572869.002.jpg
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fig2
He had a repeat CT chest with contrast after 20 months concerning his progressively worsening weight loss and smoking history which showed 1.4 cm right lower lobe lung nodule, bilateral interlobular septal thickening with lower lobe predominance, multiple bilateral ground-glass opacities, cystic changes, and multiple enlarged mediastinal lymph nodes (Figures 1 and 2).
Immunostaining showing abundant IgG4 plasma cells.
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IgG4 plasma cells (more than 50 positive cells per higher power field) (Figure 3) along with obliterative phlebitis (Figure 4), significant fibrosis (Figure 5), and arteritis as lymphoplasmacytic infiltration (Figure 6). IgG4 : IgG ratio on the lung biopsy was greater than 40%.
High power field showing obliterative phlebitis with destruction of the vessel wall.
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fig4
IgG4 plasma cells (more than 50 positive cells per higher power field) (Figure 3) along with obliterative phlebitis (Figure 4), significant fibrosis (Figure 5), and arteritis as lymphoplasmacytic infiltration (Figure 6). IgG4 : IgG ratio on the lung biopsy was greater than 40%.
High power field showing fibrous bands.
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fig5
IgG4 plasma cells (more than 50 positive cells per higher power field) (Figure 3) along with obliterative phlebitis (Figure 4), significant fibrosis (Figure 5), and arteritis as lymphoplasmacytic infiltration (Figure 6). IgG4 : IgG ratio on the lung biopsy was greater than 40%.
High power field showing arteritis with minimal obliteration of the lumen. The orange arrow shows rich lymphoplasmacytic infiltrate.
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fig6
IgG4 plasma cells (more than 50 positive cells per higher power field) (Figure 3) along with obliterative phlebitis (Figure 4), significant fibrosis (Figure 5), and arteritis as lymphoplasmacytic infiltration (Figure 6). IgG4 : IgG ratio on the lung biopsy was greater than 40%.