PMC6308371_01
Diffuse areas of ground glass. Regionally, there is interlobular septal thickening creating a crazy paving pattern (black arrows).
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A chest radiograph was made and followed by a chest-CT which demonstrated lymphadenopathy up to 13mm, diffuse ground glass opacities with superimposed interlobular thickening creating a crazy paving pattern (Fig. 1).
Specimen detail of supraclavicular lymph node biopsy. A. Hematoxylin-Eosin, lymph node is filled with middle to large size cells with perinuclear halo. B. Immunohistochemical stain for CD3 highlights neoplastic cells. C. Immunohistochemical stain shows high proliferative index Ki67. D. In situ hybridization stain for EBV-encoded RNAs was positive.
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Therefore, a surgical biopsy of a left supraclavicular lymph node was performed and the tissue examination revealed peripheral T-cell lymphoma not otherwise specified (PTCL -NOS) (Fig. 2).
Mass like consolidations in Right Middle Lobe (RML) and Right Lower Lobe (RLL) with anterior bulky displacement of the right minor fissure (arrows). Loss of volume in RLL (the asterisks indicate the position of the right major fissure).
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A new chest CT demonstrated mass-like consolidations in the right middle lobe and right lower lobe (Fig. 3).
Specimen detail from trans-thoracic lung biopsy. A. Hematoxylin-Eosin, infiltration of middle-size cells most of which contain perinuclear halo. B. Immunostain demonstrating neoplastic aggregates of CD3 (+) cells.
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Pathologic examination showed diffuse infiltration of lymphocytes in lung parenchyma with the same immunohistochemical markers as those of the lymph node biopsy (Fig. 4).