PMC7781702_01
(a, b) Axial chest CT images show an irregular shape, 1.1 cm, left upper lobe nodule with spiculated margins (block arrow), and a thin-walled parenchymal cyst in right lower lobe (arrowhead). Please note mild centrilobular, paraseptal emphysema, and a tiny, calcified right upper lobe nodule (thin arrow).
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Other imaging features included upper lobe predominant centrilobular emphysema, a few, tiny, calcified nodules, presumably old granulomas, and two small, thin-walled parenchymal cysts (Figure 1).
Axial, fused FDG PET-CT image shows increased FDG uptake in the left upper lobe nodule with SUV of 4.2 (arrow).
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The PET/CT scan displayed (18)F-fluorodeoxyglucose (FDG) avidity of the nodule with a standardized uptake value (SUV) of 4.2 (Figure 2) and no abnormal uptake elsewhere in the body.
Histologic features of the pulmonary nodule. (a) Low magnification image shows a solid appearing nodule with indistinct edges (hematoxylin-eosin stain, original magnification 8x). (b) A high magnification view exhibits marked reactive alveolar type II cell hyperplasia. The alveolar septa are expanded and contain scattered eosinophils (hematoxylin-eosin stain, original magnification 400x). (c) Another high magnification view shows alveolar macrophage accumulation at the edge of the nodule (hematoxylin-eosin stain, original magnification 400x). (d) Immunohistochemistry for langerin reveals clusters of Langerhans cells within the nodule (original magnification 400x).
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Sections of the formalin-fixed paraffin-embedded nodule revealed alveolar septal expansion with numerous eosinophils, alveolar macrophage accumulation (desquamative interstitial pneumonia-like reaction), and focal organizing pneumonia (Figure 3).