PMC6197721_01
Chest radiograph on admission showing ground-glass opacities in the lower lung fields.
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A chest radiograph showed bilateral ground-glass opacities in the lower lung fields (Fig. 1).
High-resolution computed tomography images showing the presence of centrilobular micronodules, with a "tree-in-bud" pattern and perivascular ground-glass opacities that are predominant in the lower lobes.
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Computed tomography (CT) of the chest showed ground-glass opacities with a centrilobular distribution and centrilobular micronodules with a "tree-in-bud" pattern (Fig. 2).
Transbronchial lung biopsy showing (a) infiltration of small lymphocytes in the lung parenchyma (hematoxylin-eosin staining, scale bar: 200 mum). Lymphocytes show immunoreactivity for (b) CD5, (c) CD20, and (d) CD23 (scale bar: 100 mum).
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A transbronchial lung biopsy showed lymphocytic infiltrations in the parenchyma, which were positive for CD5, CD20, and CD23 on immunohistochemical staining (Fig. 3).
Bone marrow biopsy showing (a) infiltration of small- and intermediated-sized lymphocytes into the bone marrow (hematoxylin-eosin staining, scale bar: 200 mum). Lymphocytes were immunohistochemically stained for (b) CD5, (c) CD20, and (d) CD23 (scale bar: 100 mum).
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Flow cytometric immunophenotyping of peripheral blood and a bone marrow biopsy with immunohistochemical staining showed monotypic B cells that were positive for CD5, CD20, CD19, IgD, and CD23, and negative for CD10 and cyclin D1 (Fig. 4).
High-resolution computed tomography image that was acquired 1 month after initiating fludarabine chemotherapy showing diminution of ground-glass opacities.
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One month after initiation of chemotherapy, his symptoms improved and a chest CT scan showed marked resolution of the ground-glass opacities and micronodules (Fig. 5).