PMC5394216_01
The sequential chest computed tomography (CT) axial images, with an interval period of three months. (A) shows multifocal patchy distributed ground glass opacities (GGOs) in the both lungs and consolidation at the left lower lobe; (B) shows newly developed multiple nodules superimposed on GGOs in the both lungs, only three months later.
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Chest CT showed diffuse GGOs in the both lungs and consolidation at the left lower lobe (Fig. 1A). Upon conducting a follow-up chest CT scan, newly developed multiple nodules were found to have been superimposed on GGOs in the both lungs (Fig. 1B). Upon review of sequential chest CT at the previous hospital (Fig. 1) and high LDH level, we decided to perform SLB through VATS.
Hematoxylin and eosin staining of pulmonary interstitium intravascular lymphoma (400X). Pulmonary capillaries in the interstitium are filled with tumor cells.
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On hematoxylin and eosin staining, pulmonary interstitium was filled with several atypical lymphocytes in the capillaries (Fig. 2).
CD20 immunohistochemistry staining of neoplastic intravascular lymphocytes (200X).
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Immunohistochemical staining showed tumor cells were positive for CD20 (Fig. 3) and negative for CD3, S-100, HMB45, Pan-CK, CEA and CD31.
A coronal view of the PET CT scan, without definite fluorodeoxyglucose (FDG) avid lesion.
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We found no abnormal 18-fluorodeoxyglucose (FDG) avid lesion (Fig. 4).
The sequential chest CT axial images, before (A) and after (B) the rituximab, cyclophosphamide, hydroxydaunorubicin, vincristin, and prednisolone (R-CHOP) chemotherapy. (A) shows multiple nodules superimposed on multifocal patchy distributed GGOs in the both lungs; (B) shows regression of diffuse fine nodules and multifocal patchy GGOs in the both lungs, compatible with complete remission of intravascular lymphoma of the lung (IVLBCL).
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IU/L LDH. In radiologic findings, the comparison of sequential chest CT images before and after R-CHOP treatment were also compatible with complete remission of IVLBCL (Fig. 5).