PMC4070991_01
Heterogenous round opacity with irregular margins found on the left upper zone on patient's first admission.
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Chest X-ray showed a heterogenous round opacity with irregular margins on the left upper zone (Figure 1) and chest CT scan (Figure 2) depicted a relatively large thick-walled cavitated lesion of heterogeneous density in contact with the left apical pleura.
Chest CT scan showing a cavitating lesion in the left upper lobe.
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Chest X-ray showed a heterogenous round opacity with irregular margins on the left upper zone (Figure 1) and chest CT scan (Figure 2) depicted a relatively large thick-walled cavitated lesion of heterogeneous density in contact with the left apical pleura.
H-E. (A) Inflammatory nodule (right arrow), fibroblastic area (down arrow), normal parenchyma x40 (upper arrow). (B) Inflammatory nodule (right arrow), inflammation of a bronchial wall (upper arrow), fibrotic areas included vascular spaces x100 (double arrow). (C) Lymphocytes and plasmacytes (right arrow), foamy histiocytes down field x400 (left arrow). (D) Admixed inflammatory cells (lymphoplasmacytes-right arrow and foamy histiocytes-down arrow) x400.
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The surrounding parenchyma had foci of lipoid pneumonia (Figure 3).
Immunohistochemistry. (A) Scattered kappa-chain positive plasma cells x400 (arrow). (B) Cavity area in the middle field of picture x100 (double arrow), foamy histiocytes (right arrow). (C) Scattered lambda chain positive plasma cells x100 (arrow). (D) SMA positive myofibroblasts in a fibrotic area x100 (arrow).
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Fibroblasts of the stroma expressed smooth-muscle autoantibody (SMA) positivity (Figure 4), suggesting the diagnosis of an inflammatory pseudotumor.
Normal chest-X-ray taken 3 days before discharge from hospital after re-evaluation and wedge resection of lung pseudotumor.
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The patient was discharged from hospital on 23 December 2009 in good clinical condition (Figure 5).
Heterogenous round opacity on the right upper zone on patient's admission on November 1st 2011.
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C, not responding to clarithromycin intake, administered per os at a dosage of 500 mg x2 daily. Chest X-ray film on admission showed a new, inhomogeneous opacity located in the upper zone of the right lung (Figure 6).
(A, B) Chest-X-ray without abnormal findings one year and three months after discontinuation of immunosuppressive medication.
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