PMC5760873_01
(a) Computed tomography scan image showing endobronchial mass with collapse-consolidation of left lung with mediastinal shift, (b) chest X-ray image showing complete white-out of left lung
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F1
A chest X-ray [Figure 1] showed a complete white-out of the left lung with ipsilateral mediastinal shift suggesting complete lung collapse. A contrast-enhanced computed tomography of the thorax showed an endobronchial lesion in the left main bronchus with complete collapse-consolidation of the left lung; it also showed an endobronchial lesion in the right lower lobe [Figure 1].
Bronchoscopic images of tumor, (a) the left main bronchial tumor completely obstructing the left main bronchus, (b) the right lower lobe endobronchial tumor almost completely obstructing the right bronchus intermedius
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F2
He underwent a fibreoptic bronchoscopy which confirmed a left main bronchial growth and a right lower lobar bronchial growth and a guided biopsy of these endobronchial lesions [Figure 2] was done.
Histopathological examination revealed population of highly pleomorphic malignant cells arranged in diffuse sheets (a: H&E-400X). These tumor cells were immunopositive for CD30 (membranous positivity)(b: DAB;200x) and ALK-1(nuclear as well as cytoplasmic positivity) (c: DAB;400x) while negative for AE1/AE3 (d: DAB;200x) confirming the diagnosis of Alk-positive Anaplastic large cell lymphoma
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F3
Few cells showed wreath like/horseshoe-shaped nuclei [Figure 3a]. On immunohistochemistry (IHC) the tumor cells were strongly and diffusely positive for leukocyte common antigen, while negative for cytokeratin [Figure 3d], desmin and CD3 and CD20. On additional IHC the tumor revealed strong positivity for CD30[Figure 3b] and anaplastic lymphoma kinase-1 (ALK-1)[Figure 3c].
Chest X-ray showing complete expansion of previously collapsed left lung after starting chemotherapy
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F4
His chest X-ray which had shown complete collapse before treatment also showed dramatic improvement [Figure 4].