PMC5329797_01
Initial chest computed tomography. Lung window: A B C; mediastinal window: D E F. Red arrow indicates reversed halo sign, and green arrow indicates low density area in left hilar mass.
med-2016-0010-fig001.jpg
PMC5329797_01_med-2016-0010-fig001.jpg
j_med-2016-0010_fig_001
Computed tomography (CT) of the chest demonstrated a high density shadow in the right middle lower lobe and left lower lobe, and air bronchogram was obvious (Figure 1 C). Bilateral hilar masses exits (Figure 1 E) and low density area was visible (green arrow). The crescent shaped liquid density was in right pleura (Figure 1 D). In addition to enlarged mediastinal lymph nodes, necrosis in right hilar mass is also visible in this case (Figure 1 F green arrow). Nevertheless, we also found RHS in this case (Figure 1 F red arrow).
Computed tomography guided transthoracic core needle. Puncture needle is in the consolidation area of right lower lobe.
med-2016-0010-fig002.jpg
PMC5329797_01_med-2016-0010-fig002.jpg
j_med-2016-0010_fig_002
CT-guided transthoracic core needle biopsy was performed (Figure 2). Pathological specimen was from consolidation area (Figure 2), so it indicated that PPDLBCL could cause consolidation.
Hematoxylin and eosin (H&E) staining and immunohisto-chemical staining. A: Alveolar septal broadens, and tumor cells infiltrate (HEx100); B: The tumor cells are large and rich in cytoplasm, the karyotype is slightly irregular, and nucleolus is visible (HEx400); C: immunohistochemical staining for cytokeratin (CK) (x400); D: immunohistochemical staining for CD-5 (x400); immunohistochemical staining for CD20 (x400); immunohistochemical staining for Ki-67 (x400).
med-2016-0010-fig003.jpg
PMC5329797_01_med-2016-0010-fig003.jpg
j_med-2016-0010_fig_003
Bcl-2(-), CD3(-), CD79a(+), CD23(-), CD10(-), Bcl-6(-), Syn(-), CD20(++), CD56(-) (Figure 3). Based on these findings, PPDLBCL was diagnosed.
Chest computed tomography after 6 cycles of chemotherapy. A B C; mediastinal window: D E F. Blue arrow indicates newly emerging mass.
med-2016-0010-fig004.jpg
PMC5329797_01_med-2016-0010-fig004.jpg
j_med-2016-0010_fig_004
Nevertheless, CT demonstrated bilateral masses and consolidation partially diminished (Figure 4 E F), while a new mass emerged in the right upper lobe (Figure 4 A D blue arrow).