PMC7193316_01
Changes in level of pleural effusion after treatment. Chest X-ray before treatment (A) and after treatment (B).
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Chest X-ray showed right pleural effusion (Fig. 1A). As of the time of writing, we are continuing to administer PSL at 2.5 mg/day with no apparent recurrence (Fig. 1B).
Contrast-enhanced computed tomography (CT) of the chest showed right pleural thickening, pleural effusion, mediastinal lymph node enlargement (A), and periaortitis of the abdomen and perivertebritis (B).
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Contrast-enhanced chest CT showed right pleural thickening, pleural effusion, mediastinal lymph node enlargement, periaortitis of the abdomen and perivertebritis (Fig. 2).
18F-fluorodeoxyglucose PET-CT showed that mediastinal lymph node, periaortic, and prevertebral maximum standardized uptake value (SUVmax) was 4-6. SUVmax was 2.17 at the pleura.
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SUVmax was 2.17 at the pleura (Fig. 3).
Thoracoscopic findings; mild pleural thickness with white and dense granular lesions, hypervascularization and redness in the cupula and lateral parietal pleura (A). Distention of capillaries on narrow-band imaging (B).
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Parietal pleura showed white and dense granular lesions (Fig. 4A). Pleural thickness showed mild and white with partly hypervascularization and redness in the cupula and lateral (Fig. 4A). Using narrow-band imaging, distention of capillaries were revealed among dense granular lesions (Fig. 4B).
(A) Pleural biopsy. Infiltration of inflammatory cells with tiny lymphocytes and fibrosis. (B) Mediastinal lymph node biopsy. Infiltration of inflammatory cells with small and large lymphocytes and some plasma cells. (C) Cell block of pleural effusion. Hematoxylin and eosin staining in the top image, immunohistochemical staining for IgG in the middle image, and immunohistochemical staining for IgG4 in the bottom image. The ratio of IgG4-to IgG-positive plasma cells (IgG4/IgG) is 22.4% (A), about 50% (B), and could not be evaluated (C).
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The ratio of IgG4-to IgG-positive plasma cells (IgG4/IgG) was 22.4%, and 10 IgG4-positive cells were seen on a high-power field (HPF) (Fig. 5A). IgG4/IgG could not be evaluated (Fig. 5B). A cell block of pleural effusion suggested that IgG4/IgG was about 50% (Fig. 5C).