PMC9352445_01
CT of the chest following treatment for peripheral T-cell lymphoma showing a new 1.2 cm nodule in the medial right lower lobe just posterolateral to the distal bronchus intermedius. The nodule appears solid with smooth and spiculated margins and surrounding subtle interstitial thickening. No other obvious abnormalities were noted on CT imaging.
CRIPU2022-7481636.001.jpg
PMC9352445_01_CRIPU2022-7481636.001.jpg
fig1
However, a new 1.2 cm pulmonary nodule was seen in the superior-medial aspect of the right lower lobe just lateral to the distal bronchus intermedius (Figure 1).
PET-CT scan showing the hypermetabolic nodule with a SUV of 5.7, concerning for a possible primary pulmonary malignancy.
CRIPU2022-7481636.002.jpg
PMC9352445_01_CRIPU2022-7481636.002.jpg
fig2
A subsequent positron emission tomography-CT (PET-CT) scan revealed this nodule to be hypermetabolic with a standardized uptake value (SUV) of 5.7, raising the suspicion for a possible primary pulmonary malignancy (Figure 2).
Bronchoscopy with EBUS showing an enlarged right hilar nodule.
CRIPU2022-7481636.003.jpg
PMC9352445_01_CRIPU2022-7481636.003.jpg
fig3
A repeat EBUS was performed, and the area of interest was identified (Figure 3).
Hematoxylin and eosin stain of surgical biopsy showing multiple necrotizing granulomas, some of which are surrounded by organizing pneumonia.
CRIPU2022-7481636.004.jpg
PMC9352445_01_CRIPU2022-7481636.004.jpg
fig4
Pathology from the dominant nodule revealed multiple necrotizing granulomas, some of which were surrounded by organizing pneumonia (Figure 4).
Gomori methenamine silver stain showing organisms compatible with Pneumocystis jirovecii.
CRIPU2022-7481636.005.jpg
PMC9352445_01_CRIPU2022-7481636.005.jpg
fig5
Grocott methenamine silver (GMS) stain demonstrated clusters of organisms compatible with Pneumocystis in the center of these granulomas (Figure 5).