PMC8349034_01
Chest CT findings at the time of admission (A), after the administration of a corticosteroid and tacrolimus (B), and after six cycles of chemotherapy (C). Conventional CT of the chest revealing mosaic attenuation, with patchy GGOs and a slight subpleural consolidation at the time of admission (A). Even after initiating steroid and tacrolimus therapy, GGOs and consolidation worsen (B). Mosaic attenuation, GGOs, and consolidation in both lungs are improved after chemotherapy (C). CT: computed tomography, GGO: ground-glass opacity.
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Chest computed tomography (CT) demonstrated a bilateral mosaic attenuation pattern, with enlarged pulmonary arteries and patchy GGOs with consolidation (Fig. 1 A). However, even after the start of steroid therapy, her respiratory status and CT findings did not improve; in fact, they continued to worsen, despite the subsequent administration of pulse steroid therapy (methylprednisolone: 1000 mg) with tacrolimus treatment (Fig. 1 B). After initiation of chemotherapy, the patient's respiratory status and radiological findings (assessed by chest CT and pulmonary perfusion scintigraphy) improved concomitantly with a reduction in the size of the tumor (Fig. 1 B-C, Fig. 2 A-B).
Pulmonary perfusion scintigraphy findings before chemotherapy (A) and after chemotherapy (B). PET-CT findings used to diagnose uterine cervical cancer (C-D). Pulmonary perfusion scintigraphy showing multiple small peripheral perfusion defects in both lungs (A). The defects are improved after chemotherapy (B). PET-CT revealing FDG accumulation with consolidation in both lungs (C) and in the uterine cervix (D). PET-CT: Position emission tomography-computed tomography, FDG: Fluorodeoxyglucose (18F).
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Pulmonary perfusion scintigraphy revealed multiple small peripheral perfusion defects in both lungs (Fig. 2 A). PET-CT showed fluorodeoxyglucose (FDG) accumulation in the lungs, with consolidation, as well as in the uterine cervix (Fig. 2 C-D).
EBUS-TBLB reveals pulmonary arteriolar stenosis by fibrointimal proliferation of fibroblasts and collagen (A-B). Only a single cell consistent with the characteristics of squamous cell carcinoma can be identified in the cytologic smears of pulmonary arterial blood aspirated from a catheter in the wedge position (C). EBUS-TBLB: endobronchial ultrasound-guided transbronchial lung biopsy. (A: Hematoxylin and eosin staining at x 200, B: Elastica-Masson staining at x 200, C: Papanicolaou staining at x 1000).
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The EBUS-TBLB revealed no malignant cells; however, arteriole stenosis with fibrous intimal thickening was observed (Fig. 3 A-B). Cytologic smears of pulmonary wedge arterial blood exhibited only a single atypical cell, characterized by a large, grooved nucleus containing coarsely granular chromatin, dense, round cytoplasm, and high nuclear/cytoplasmic ratio; these findings were compatible with the characteristics of squamous cell carcinoma (Fig. 3 C).