PMC4821448_01
A) CT Chest revealing left lower lobe mass with irregular margins (5 x 3.5 cm), B) PET Scan with increased uptake in the corresponding left lower lobe mass and increased uptake in the right hilar region.
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Contrast enhanced chest CT revealed a 5.0 x 3.5 cm mass in the left lower lobe and right hilar fullness (Fig. 1A). Positron Emission Tomography (PET) showed increased uptake in the left lower lobe and the right hilum (Fig. 1B).
Left lower lobe wedge biopsy with lymphoid aggregates (abundant plasma cells) and dense fibrosis.
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Histopathological examination revealed a mixed inflammatory infiltrate with abundant plasma cells associated with fibrosis in a patchy, nodular distribution (Fig. 2).
Arrows indicate IgG4 positive staining of plasma cells on immunohistochemistry.
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Immunohistochemistry showed reactivity to IgG4 (Fig. 3) and thyroid transcription factor 1.