PMC9358449_01
Chest computed tomography scans in the upper and lower lobes showing slowly progressive diffuse centrilobular nodules. (A, B, C, D, E and F were obtained in 2008, 2010, 2012, 2014, 2016, and 2018, respectively. 1: Upper area of the lung, 2: Lower area of the lung).
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Chest CT showed bilateral diffuse centrilobular pulmonary nodules (Fig. 1). The patient has currently not received any treatment, and the pulmonary nodules have been growing in size on chest CT (Fig. 1).
(A), View of the first surgical biopsy in 2013, which shows lymphoplasmacyte infiltration into the interstitium, peribronchovascular sheath, and subpleura (20x). Inset: High-power view showing storiform fibrosis (100x). (B-1), HE staining in the first surgical biopsy (x200). (B-2), IgG4 staining in the first surgical biopsy (x200). (B-3), IgG staining in the first surgical biopsy (x200). An IgG4/IgG-ratio of 50%. (C), View of the second surgical biopsy in 2016, which shows lamellar hyalinized collagen bundles around bronchovascular bundles with an associated dense rim of plasma cells and lymphocytes (100x).
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Pathological assessment of the resected lymph nodules also revealed 200 IgG4-positive plasma cells/high-power field (HPF) and an IgG4/IgG-ratio of 50% (Fig. 2). Furthermore, there was no epithelioid cell granuloma in the second biopsy (Fig. 2).