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(a) H&E stain reveals a well-circumscribed mass composed of numerous plasma cells and lymphocytes in a background of dense fibrosis. (b) In-situ hybridization for kappa (left) and lambda (right) light chains shows a polyclonal mix of plasma cells. (c) An immunostain for ALK-1 is negative and ALK FISH is negative for a translocation.
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Histopathological examination of the excisional biopsies showed a well-circumscribed lesion with dense fibrosis and numerous plasma cells and lymphocytes (Figure 1).
CT imaging showing new nodular opacity in the lingula in cross section (a) and coronal plane (b).
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Five years later the patient developed progression of the nodular opacity in the lingula (Figure 2) similarly to what was seen on initial presentation.
CT imaging showing resolution of previously seen nodular opacity in the lingula post radiation therapy in cross section (a) and coronal view (b).
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Both CT and endobronchial ultrasound guided needle biopsies were non-diagnostic, with the biopsy showing only histiocytes and benign bronchial cells (Figure 3). A follow up scan after 3 months showed a partial response and subsequent CT imaging 6 months later (Figure 3) without any further treatment showed near complete resolution of the lesion.