PMC9960853_01
CXR and chest CT images on admission and after admission.. CXR on admission showed diffuse ground-glass opacities in both lungs (A). After discharge from the hospital, CXR showed new infiltrative shadows in addition to diffuse ground-glass opacities in both lungs (B). Chest CT on admission showed diffuse ground-glass opacities in both lungs with thickening of the interlobular septal wall (red arrow) (D). The chest CT showed new infiltrative shadows in addition to diffuse ground-glass opacities in both lungs (red arrowhead) (E). CXR and chest CT before VATS lung biopsy showed further exacerbation of the previous imaging findings (C, F). Contrast-enhanced CT of the abdomen on admission, showing hepatosplenomegaly (G) and bilateral kidney enlargement (H).
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FIG1
Chest radiography (CXR) revealed ground-glass opacities in both lung fields (Figure 1A). Chest computed tomography (CT) revealed diffuse ground-glass opacities with interlobular septal thickening (Figure 1D). Mild hepatosplenomegaly and bilateral kidney enlargement were also observed (Figures 1G, 1H). The CXR and CT scans, in addition to diffuse ground-glass opacities, also showed the appearance of mass-like infiltrates with moderate pleural effusion in both lungs (Figures 1B, 1E).
Pulmonary pathology by TBB.. Pulmonary pathology by TBB showed infiltration of lymphocytes and plasma cells in the interstitium. Some slightly enlarged lymphocyte-like cells were seen, but it was difficult to distinguish them from lymphoma (C HE staining, original magnification, x400).
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FIG2
TBB showed lymphocyte infiltration, but no non-caseating epithelioid cell granulomas were seen in sarcoidosis (Figure 2).
Renal biopsy tissue.. Lymphocytic infiltrate was observed in the interstitium (B HE staining, original magnification, x400).
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FIG3
The pathological diagnosis was interstitial nephritis (Figure 3).
Lung tissue biopsied by VATS.
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FIG4
These examinations were performed using integrated analysis of malignant lymphoma, ML-NET (Figures 4, 5).
Lung tissue sectioning by a pathologist to differentiate primary pulmonary malignant lymphoma.
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FIG5
These examinations were performed using integrated analysis of malignant lymphoma, ML-NET (Figures 4, 5).
VATS lung biopsy tissue.. Infiltration of lymphocytes and plasma cells was observed in the interstitium. Some slightly enlarged lymphocyte-like cells were seen (HE staining, original magnification, x400).
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FIG6
Hematoxylin-eosin staining showed an increase in medium-sized lymphocytes and slightly larger lymphocyte-like cells (Figure 6).
CD56 immunostaining in VATS lung biopsy tissue. . Immunostaining in VATS lung biopsy tissue showed medium-sized lymphocytes were partially CD56 positive (original magnification, x400).
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FIG7
Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).
CD8 immunostaining in VATS lung biopsy tissue.. Immunostaining in VATS lung biopsy tissue showed medium-sized lymphocytes were partially CD8 positive (original magnification, x400).
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FIG8
Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).
TIA-1 immunostaining in VATS lung biopsy tissue.. Immunostaining in VATS lung biopsy tissue showed medium-sized lymphocytes were TIA-1 positive (original magnification, x400).
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FIG9
Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).
GranzymeB immunostaining in VATS lung biopsy tissue.. Immunostaining in VATS lung biopsy tissue showed medium-sized lymphocytes were granzymeB positive (original magnification, x400).
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FIG10
Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).
EBV-encoded RNA ISH in VATS lung biopsy tissue.. Immunostaining in VATS lung biopsy tissue showed EBV-encoded RNA ISH positive (original magnification, x400).
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FIG11
Immunostaining showed CD3, CD56 (partial positive) (Figure 7) and CD8 (Figure 8), CD2, T-cell intracellular antigen-1 (TIA-1) (Figure 9), granzyme B (Figure 10) positive, CD20 negative, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (ISH) positive (Figure 11), poor proliferation (G-band), and no ALK mutated gene (fluorescence ISH).