PMC6818345_01
Chest computed tomography of the nodule in the upper lobe of the right lung. No change was observed during the course of observation. A. The nodule when it was first detected. B. Ten months after the time from 1A. C. Eighteen months after the time from 1B (the same period represented in Fig. 4A). D. Twelve months after the time represented in Fig. 1C (the same period represented in Fig. 4B). E. Eighteen months after the time from Fig. 1C (the same period represented in Fig. 4C).
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The nodule had remained unchanged for 10 months (Fig. 1A and B). Chest computed tomography (CT) revealed a 15-mm nodular shadow with slightly irregular margins in the upper lobe of the right lung (Fig. 1). During the subsequent follow-up period the lesion in the right upper lobe did not exhibit any changes in size or other characteristics (Fig. 1).
A. Chest computed tomography (CT) revealed a 15-mm irregularly shaped nodule in the upper lobe of the right lung. The nodule shadow was unchanged after 10 months of observation. B. Chest CT revealed a small new 5-mm nodular lesion in the left lung apex, which gradually increased in size over the course of 10 months (red arrow). C. Enlargement of the right axillary lymph nodes, with no enhancement effect (red square). D. Positron emission tomography-CT depicting 18F-fluorodeoxyglucose uptake in the left lung apex and right axillary lymph nodes. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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The patient was monitored as an outpatient for 18 months, during which time no changes in the size or characteristics of the nodular shadow in the right upper lobe of the lung were observed (Fig. 2A). A small 5-mm node appeared as a new lesion in the left lung apex, however, and it gradually increased to 10 mm over the course of 10 months (Fig. 2B). No enhancement effect was detected via contrast CT (Fig. 2C). Accumulation was detected in the left lung apex and right axillary lymph node via positron emission tomography-CT (Fig. 2D), but no accumulation was depicted in the right lung nodule.
The right axillary lymph nodes where biopsied. Hematoxylin and eosin staining depicted a large number of epithelioid granulomas and multinucleated giant cells in the tissue.
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Large numbers of epithelioid granulomas and multinucleated giant cells were detected in the biopsy tissue (Fig. 3).
A. Nodules in the left upper lobe (red arrow) and right axillary lymph node (red square) before lymph node biopsy. B. Lesions 1 year after biopsy. C. Chest nodule and axillary lymph nodes after 18 months. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Interestingly the nodule in the left upper lobe gradually shrunk over the course of one year, as did the right axillary lymph nodes (Fig. 4A and B). The nodule had almost disappeared after 18 months (Fig. 4C).