PMC5392773_01
Chest radiography and computed tomography obtained on admission. (A) Chest radiograph shows ground glass opacity in the right lower lung field (black arrow). (B) Chest computed tomography shows multiple cysts (white arrows) and nodules (black arrow) on both lungs.
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Chest X-ray showed a ground glass opacity lesion in the right middle lung (Fig. 1A). Chest CT revealed multiple cysts and nodules on both lungs, with cervical and axillary lymph node swelling (Fig. 1B).
Histopathological finding of the right cervical lymph node biopsied surgically (A) Cervical lymph node shows lymphocyte and plasma cell infiltration (Hematoxylin-eosin stain, x400). Immunohistochemical staining with (B) IgG (x400) and (C) IgG4 (x400) shows an IgG4/IgG-positive cell ratio of about 40%.
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Surgical biopsy from the right cervical lymph node showed lymphoplasmacytic infiltration (Fig. 2A). Immunohistochemicalstaining for biopsied lymph node indicated that more than 40% of the total plasma cells were IgG4-positive (Fig. 2B and 2C).
Histopathological finding of video-assisted thoracic surgery specimen from the right S6. (A) Video-assisted thoracic surgery specimen from the right S6 shows lymphocyte and plasma cell infiltration and cysts (Hematoxylin-eosin, x200), (B) as well as the presence of fibrosis (white arrow, Hematoxylin-eosin, x400). (C) Immunohistochemical staining with IgG and (D) IgG4 (x400) shows an IgG4/IgG-positive cell ratio of about 40%. (E) Immunohistochemical staining with IgG4 (x800) shows 10 cells/hpf.
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Histologic findings of the biopsied lung were similar with those of the lymph node, as well as the presence of some fibrotic areas on hematoxylin and eosin stain (Fig. 3), we diagnosed the case as IgG4-RD.