PMC7723813_01
Representative computed tomography images. Swollen lymph nodes in the mediastinum (arrows) (A), soft tissue shadow in the paravertebral region (B), centrilobular and paraseptal emphysema in the upper lobes (C), and ground glass opacities and mild reticulation (D).
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An enhanced chest CT revealed emphysema dominant in the upper lung field, GGO in the lower lung field, interlobular septal thickening, mediastinal lymphadenopathy, and a soft tissue shadow in the paravertebral region (Fig. 1).
Ill-defined soft tissue attenuation and FDG accumulation were observed in the mediastinum (SUVmax = 2.5) (A), pleura (B), and retroperitoneum (SUVmax = 2.4) (C).
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The histology of the lymph node biopsy specimens. Infiltration of small lymphocytes and plasma cells (Hematoxylin-Eosin Staining) (A, 200 x magnification). In situ hybridization for immunoglobulin light chains (B, kappa; C, lambda, 200 x magnification). Most of the plasma cells were positive for immunoglobulin light chain kappa.
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The lymph node specimen and the surrounding connective tissue revealed small lymphocytes and plasma cells between follicles (Fig. 3A). In situ hybridization (ISH) revealed immunoglobulin light-chain restriction with an elevated kappa/lambda ratio of ten (Fig. 3B and C).
MYD88 L265P mutation was detected by polymerase chain reaction with paraffin embedded tissue. Leucine (CTC) was converted to proline (CCC).
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DNA was extracted from paraffin-embedded tissue and a mutation analysis using an allele-specific primer-polymerase chain reaction (PCR) confirmed MYD88 L265P mutation in lymph node specimens (a substitution of leucine with proline at amino acid position 265) (Fig. 4).
The histology of the lymph node biopsy specimens. The deposition of acidophilic amorphous deposits was found in the lymph nodes (Hematoxylin-Eosin Staining) (A, 40 x magnification). Extracellular amorphous and eosinophilic deposits stained positively by Congo red (B, 40 x magnification) and exhibited apple green color under polarized light (C, 40 x magnification) and were positive for AL kappa by immunohistochemistry (D, 40 x magnification). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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