PMC5828649_01
(a) and (b) HRCT of the chest at diagnosis shows bilateral centrilobular nodules, thickening of the interlobular septa, and mediastinal lymphadenopathy. (c) and (d) Histological findings of the pulmonary nodule show infiltration of polyclonal plasma cells around the bronchovascular bundles and in the interfollicular areas of the nodes (H&E, 50x and 200x). (e) and (f) Sheets of mature plasma cells are present within the interfollicular region and are highlighted by positive immunostaining of IgG- and IgG4-negative plasma cells (immunohistochemistry, 200x).
CRIHEM2018-5895903.001.jpg
PMC5828649_01_CRIHEM2018-5895903.001.jpg
fig1
C-reactive protein, and polyclonal hypergammaglobulinemia. Computed tomogram demonstrated diffuse (lung, axillary, and mediastinal) lymphadenopathy, interstitial pneumonitis, and splenomegaly (Figures 1 and 1). Histology of left pulmonary nodule accessed by thoracic surgery revealed atretic follicles with plasmacytosis, prominent paracortical vascularity, and sinus histiocytosis with an overall appearance consistent with MCD (Figures 1 and 1). Immunohistochemistry for IgG and CD138 was positive, and IgG4 was negative (Figures 1 and 1).
(a) and (b) Pathological section demonstrated the structural breakdown and significant hypercellularity with hyperplastic granulopoiesis (H&E, 50x and 200x).
CRIHEM2018-5895903.002.jpg
PMC5828649_01_CRIHEM2018-5895903.002.jpg
fig2
Subsequently, she underwent laparoscopic splenectomy, and the pathological section demonstrated the structural breakdown and significant hypercellularity (Figures 2 and 2).
Blood counts of the patient during chronic treatment with prednisone and cyclophosphamide to MCD and conservative treatment with DAC. WBC and PLT used right-sided y-axis, while left-sided y-axis was used for Hb and monocytes.
CRIHEM2018-5895903.003.jpg
PMC5828649_01_CRIHEM2018-5895903.003.jpg
fig3
Surprisingly, after just one cycle, the WBC count had declined to 15,000/muL and the Hb increased to 9.0 g/dL and PLT to 220,000/muL (Figure 3).