PMC10358746_01
(a) Chest CT showing large patches and a patchy increased density in both lungs, and multiple bronchial stenoses in both lungs. (b and c) Head MRI showing irregular masses in the fourth ventricle, with a larger cross-section of approximately 21 mm x 24 mm, spreading along the bilateral lateral foramen of the fourth ventricle, and the sinus bone and surrounding pia mater were intact.
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An auxiliary examination included a chest CT, which showed large patches, patchy increased densities in both lungs, and multiple bronchial stenoses in both of her lungs (Figure 1a). The sinus bone and surrounding pia mater were intact, and tumorous lesions were suspected (Figure 1b and c).
Histopathology and immunohistochemistry: histopathology: (a) There was an abscess formed by liquefaction necrosis, the epithelioid cells around the abscess were arranged in a fence to form granulomas, and a large number of inflammatory cells infiltrated in the interstitium (single arrow abscess, double arrow granulomas, x100). (b and c) Vasculitis: small blood vessels infiltration of plasma cells, lymphocytes, and neutrophils into the wall, fibrinoid necrosis is not obvious (x100) (single arrow vasculitis, x200). (d and e) A large number of epithelioid cells around the blood vessels form a granulomatous vasculitis (d: single arrow granulomatous vasculitis, x100; e: single arrow epithelioid cells, x200). Immunohistochemistry: (f) there was positive CD68 expression in epithelioid cells (x100).
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The presence of fibrinoid necrosis was not obvious (Figure 2b and c), and a large number of epithelioid cells were around the blood vessels. Surrounding the formation of granulomatous vasculitis (Figure 2d and e), the necrosis included liquefaction necrosis that formed abscesses. The epithelioid cells around the abscesses were arranged in a fence to form granulomas, and there were a large number of neutrophils, lymphocytes, tissue cells, and a small amount of plasma cell infiltration (Figure 2a). Immunohistochemistry was positive for CD68 (Figure 2f) and was negative for glial fibrillary acidic protein (GFAP).