PMC8093052_01
High-resolution computed tomography of the chest (Case 1). (a) Confluent ground glass opacity and consolidation, mainly in the mid and lower lungs, associated with moderate traction bronchiectasis. The distribution is partially subpleural with extension along the bronchial vascular bundles. Lung volumes are markedly reduced. (b) Coronal view demonstrating peri-diaphragmatic consolidation with an abrupt transition to normal parenchyma.
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fig1
An HRCT scan of the chest demonstrated extensive ground glass abnormality with traction bronchiectasis, in a distribution highly suggestive of non-specific interstitial pneumonia (NSIP) (Figure 1).
Surgical biopsy of the right lung (Case 1) demonstrates features of mixed cellular-fibrotic non-specific interstitial pneumonia (a) with scattered foci of organizing pneumonia (arrow) (b).
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Prior to referral to tertiary care, the patient had undergone surgical lung biopsy, which demonstrated a mixed cellular/fibrotic pattern along with scattered foci of organizing pneumonia (Figure 2).
PMC8093052_02
High-resolution computed tomography of the chest (Case 2). The scan 10 months prior to our evaluation (a) demonstrated a typical appearance of non-specific interstitial pneumonia (NSIP) with increased reticulation, traction bronchiectasis, lobar volume loss, and ground glass opacification in the lower lung zones. Bibasilar ground glass opacities that spare the subpleural region are characteristic for NSIP. The scan taken at our center 10 months later (b) demonstrated significant progression in fibrotic abnormalities.
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fig3
HRCT scan of the chest, which demonstrated an NSIP pattern (Figure 3). An HRCT scan demonstrated significant progression in fibrotic abnormalities compared to the HRCT scan taken 10 months previously, with a typical imaging appearance of NSIP (Figure 3).
PMC8093052_03
High-resolution computed tomography of the chest (Case 3). The scan prior to our evaluation (a) demonstrated pulmonary nodules, thin-walled cysts, basilar predominant ground glass attenuation, and subpleural consolidation consistent with lymphocytic interstitial pneumonia (LIP) in the setting of Sjogren's syndrome. A repeat scan (b) demonstrated increased ground glass attenuation and stable thick-walled cysts, and a few of the bilateral solid pulmonary nodules had slightly increased in size.
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An HRCT scan of the chest prior to our evaluation demonstrated pulmonary nodules, thin-walled cysts, basilar predominant ground glass attenuation, and subpleural consolidation (Figure 4(a)). The pattern was consistent with lymphocytic interstitial pneumonia (LIP) in the setting of Sjogren's syndrome (Figure 4(b)).
Computed tomography- (CT-) guided lung biopsy (Case 3). Hematoxylin and eosin stain (a) demonstrates amorphic eosinophilic material reminiscent of an amyloid process, whereas both kappa staining (b) and lambda staining (c) demonstrate mixed light chain deposition.
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fig5
This was unremarkable for malignancy; however, immunohistochemistry was consistent with light chain amyloid, while the kappa light chain staining was the strongest (Figure 5).