PMC5926509_01
A chest X-ray revealed consolidation of the right upper lung field.
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A chest X-ray showed consolidation in the right upper lung field (Fig. 1).
Contrast-enhanced whole-body CT disclosed a right axillary lymphadenopathy (A), a tumor mass in the right hilum and partial right upper lobe atelectasis (B).
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Contrast-enhanced whole-body computed tomography (CT) disclosed a right axillary lymphadenopathy and a right hilar mass with obstruction of the main bronchus (Fig. 2). 18-F-fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed an abnormal FDG accumulation in the subcutaneous nodules on the mandibular and left chest wall, a part of the trachea, lymph nodes (submandibular, right axillary and mediastinal), right hilar mass, retroperitoneal mass and mass in the right femoral muscle with high metabolic activity (SUVmax: 5.75-21.1) (Fig. 3).
FDG PET revealed an abnormal FDG accumulation in the subcutaneous nodules on the mandibular (A) and left chest wall (F), a part of the trachea (B), lymph nodes (submandibular, right axillary and mediastinal), right hilar mass (C,D,E), retroperitoneal mass (G) and mass in the right femoral muscle (H) with high metabolic activity (SUVmax: 5.75-21.1).
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Contrast-enhanced whole-body computed tomography (CT) disclosed a right axillary lymphadenopathy and a right hilar mass with obstruction of the main bronchus (Fig. 2). 18-F-fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed an abnormal FDG accumulation in the subcutaneous nodules on the mandibular and left chest wall, a part of the trachea, lymph nodes (submandibular, right axillary and mediastinal), right hilar mass, retroperitoneal mass and mass in the right femoral muscle with high metabolic activity (SUVmax: 5.75-21.1) (Fig. 3).
Bronchoscopy showed an ulcerative lesion just below the glottis (A), and a white necrotic material block in the right upper bronchus (B). C and D are bronchoscopic findings of the right upper bronchus after removal of necrotic material. The bronchial mucosa was hemorrhagic and highly stenosed.
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Bronchoscopy showed a white, moss-like appearance of the trachea just below the glottis and right B3 entrance stenosis with a large amount of purulent discharge (Fig. 4).
A and B are pathological findings of biopsied tissue from the mucosal lesion of the right B3 entrance (HE & CD3 staining). Submucosal invasion of medium-to large-sized atypical lymphocytes is shown. C and D are pathological findings of biopsied tissue from the subcutaneous nodule. Atypical lymphocyte infiltration similar to the bronchial lesion was found.
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An immunohistochemical study revealed focal positive staining for CD3, CD8, TIA-1, and C:C chemokine receptor type 4 (CCR4), and negative staining for CD4, CD20, and EBV (Fig. 5A and B). In addition, a biopsy of the subcutaneous nodules on the left chest wall also showed the same findings (Fig. 5C and D).
CT images showed the marked reduction in the right hilar mass and multiple lymphadenopathies after five cycles of chemotherapy.
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After five cycles of chemotherapy, contrast-enhanced whole-body CT showed a reduction in the right hilar mass and all of the lymph nodes (right axillary, mental, submandibular, cervical, subcarinal, splenic hilar and retroperitoneal region) (Fig. 6), with a partial response according to the Response Evaluation Criteria in Solid Tumors (version 1.1).