PMC9625112_01
Chest computed tomography images showing. (A) A lobulated mass with pleural retraction in the posterobasal segment of the right lower lobe (RLL) and multiple tiny nodules in both lungs at the time of diagnosis. (B) Four months after initiating crizotinib, bilateral ground-glass opacities were observed, despite an obvious decrease in the size of the primary tumor in the RLL and multiple nodules in both lungs. (C) Nine weeks after crizotinib retreatment, a further decrease in the size of the primary RLL tumor and almost complete clearing of the bilateral ground-glass opacities was seen, without recurrence of ILD. (D) Transbronchial lung biopsy specimen showing patchy lymphocytic infiltration of the peribronchiolar interstitium and intra-alveolar accumulation of foamy macrophages (hematoxylin-eosin stain, x100). (E) Photograph of the non-diagnostic, yellowish fluid aspirated through bonchoalveolar lavage.
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Chinese women residing in Korea, with no smoking history, presented with a 2-week history of a non-productive cough and palpable neck lymph nodes (LNs). Chest computed tomography (CT) showed a right lower lobe (RLL) mass with lung-to-lung metastases and pleural retraction ( Figure 1A ), and she was diagnosed with stage IV lung adenocarcinoma (cT4N3M1c) with two brain metastases. Chest CT revealed newly developed extensive diffuse ground-glass opacities throughout both lungs, despite obvious shrinkage of the RLL primary tumor and multiple additional nodules ( Figure 1B ). Bronchoalveolar lavage (BAL) identified 94% lymphocytes, 2% monocytes and transbronchial lung biopsy demonstrated patchy lymphocytic infiltration of the peribronchiolar interstitium ( Figure 1D ). Echocardiography, laboratory tests, and BAL fluids ( Figure 1E ) showed no evidence of heart failure, rheumatologic diseases, pulmonary infections, or progression of lung cancer. The steroid dose has been gradually and successfully tapered and, at 9 weeks after crizotinib retreatment, there was neither disease progression nor recurrence of ILD ( Figure 1C ).