PMC7170125_01
First case: PET/TC showing the right pulmonary lesion
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F1
Eight years of follow-up with PET/TC showed a variable uptake of right pulmonary lesion (SUV from 0 to 2.3), while in 2016 a PET/TC control showed an increased uptake of the right pulmonary lesion (SUV 20.1) with increased volume (41x22 mm), and the presence of two new nodular areas in the middle lobe (Figure 1).
First case: non-necrotizing coalescing granulomas of epithelioid cells with central multinucleated giant cells, peripheral lymphocytes and collagen
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F2
PMC7170125_02
Second case: total body CT showing the increased volume of hilar and mediastinal lymph nodes
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F3
IRI - irinotecan), and then a maintenance therapy with Erbitux. In January 2015, a total body CT scan revealed an increased volume of hilar and mediastinal lymph nodes with elevated uptake at PET scan (SUV 22), indicative for disease progression (Figure 3).
Second case: endobronchial biopsy showing epithelioid granulomas with giant cells in the lamina propria
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F4
Histology suggested non-caseating chronic granulomatous inflammatory process (simil sarcoidosis) (Figure 4).
PMC7170125_03
Third case: PET/CT showing multiple nodular lesions in the spleen
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F5
Five years later, during the follow-up in September 2011, a total body PET/CT scan detected some small pulmonary parenchymal nodules (5 mm) indicative for metastasis, enlarged mediastinal lymph nodes (max 15 mm) and multiple nodular lesions in the spleen (25 mm, SUV max 7.1), in absence of other sites of uptake (Figure 5).
Third case: non-necrotizing granulomatous giant cells in the spleen
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F6