PMC10160796_01
(A) Axial fusion image of FDG PET/CT scan showing hypermetabolic adenopathy in the
mediastinum, hypermetabolic lung nodules, and hypermetabolic bone lesions seen in both
scapula. (B) Coronal fusion images of FDG PET/CT scan showing hypermetabolic liver
lesions, hypermetabolic diffuse extensive bone lesions, and hypermetabolic
lymphadenopathy and lung lesions in the chest. (C) Maximum intensity projection image of
FDG PET/CT scan shows diffuse hypermetabolic disease in chest, liver, and bones. (D)
Lung window images during FDG PET/CT scan showing bilateral small pulmonary nodules.
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Enlarged mediastinal, bilateral hilar, bilateral axillary, abdominal, and pelvic lymph nodes were noted (Figure 1A to D).
(A) Liver biopsy showing non-caseating granulomas replace a large portion of hepatic
parenchyma (H&E 20X). (B) Liver biopsy showing numerous non-caseating granulomas
(white arrow) composed of tightly packed epithelioid histiocytes without associated
necrosis, caseation, or acute inflammation (H&E 40X). (C) Liver biopsy showing rare
Langerhans-type multi-nucleated giant cells are associated with the granulomas (white
arrow) (H&E 40X).
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The liver was almost completely replaced by back to back non-caseating granulomas (Figure 2A). These granulomas were small and composed of tightly packed epithelioid histiocytes without associated necrosis, caseation, or acute inflammation (Figure 2B). Rare Langerhans-type multi nucleated giant cells were noted (Figure 2C).