PMC3203974_01
Chest computer tomography (CT) scans showing different image patterns along the years. A: December, 2004: the initial clinical presentation as a subpleural solitary pulmonary nodule in the right inferior lobe with adjacent subpleural opacities. The nodule was resected and diagnosed as an inflammatory pseudotumor. B: Three years later, CT scans with multiple spiculated pulmonary nodules surronded with ground glass halo and architectural distortion of the adjacent parenchyma. C and D: June, 2008: Pulmonary nodule with ground glass halo in the middle lobe along with consolidation in the left inferior lobe resembling organizing pneumonia. There was a complete response after corticosteroid treatment.
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Chest CTs over the years showed different image patterns and indicated predominantly bilateral peripheral nodules or subpleural consolidations with a ground-glass halo (Figure 1 and 2).
Chest CT scans obtained in 2009. On the left column, solitary pulmonary nodule in the upper right lobe along with parenchimal bands in the inferior right lobe. Five months later, the right upper nodule disappeared, but other nodules surrounded with ground glass halo appeared in the inferior lobes bilaterally.
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Chest CTs over the years showed different image patterns and indicated predominantly bilateral peripheral nodules or subpleural consolidations with a ground-glass halo (Figure 1 and 2).
Lung biopsy of the pulmonary nodule. A: Nodular fibrous lesion with immunopositivity for IgG4 in the infiltrating plasma cells (Verhoeff-Masson trichrome stain, original magnification x 2); B: Plasmacytic infiltration of the fibrous lesion (H&E stain, magnification x 100); C: Occlusive vascular lesion with plasmacytic infiltration (H&E stain, magnification x 100); D: Immunopositivity for IgG4 in the infiltrating plasma cells (Verhoeff-Masson trichrome stain, original magnification x 100).
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Most of the infiltrating plasma cells were positive for IgG4, and the IgG4/IgG ratio was greater than 90% (Figure 3).