PMC9932527_01
(A) Lung window on chest CT. The figure shows the multiple "ground glass" blurred shadows on both lungs (shown by the white arrow); the upper lobe of the right lung shows multiple nodular foci, one of which is larger (shown by the black arrow), showing a thick-walled cavity, and the edge of the lesion has multiple small nodule foci (shown by the red arrow). (B) Mediastinal window on chest CT. The figure shows a thick-walled cavity shadow (shown by a black arrow) in a larger nodular foci of the upper lobe of the right lung. The inner wall of the cavity is still smooth, the adjacent pleural traction is changed, the marginal small nodule foci are slightly displayed (shown by the red arrow), and the deposition of granular materials is visible.
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Chest CT done three weeks ago suggested diffuse lesions and localized emphysema, thick-walled cavities and multiple nodules seen in both pulmonary and mediastinal windows ( Figures 1A, B ).
(A) Alveolar lavage fluid Wright-Giemsa Stained x1000. Nucleated cells are significantly increased, easy to see piles, or scattered macrophages, macrophages can be seen round, or circular; soma medium in size, or enlarged; Swallow a large number of black gray, or brown-black particles, different sizes, different shades of coloring, cytoplasmic internal cause is full of a large number of particles, so that the soma swells, cytoplasm is aggregated or scattered black masses, the nucleus is squeezed by particles, distributed at the edge of the cell, or because of particle covering, the structure of the nucleus cannot be seen clearly, macrophage soma that swallows a large number of particles is easy to apoptosis, rupture, nucleus chromatin is loose, granules are scattered due to cell rupture. (B) Alveolar lavage solution, Prussian blue staining x1000. Cytoplasmic macrophages filled with iron granules stained blue. Prussian blue staining positive reaction, a large number of granules covered leading to unclear cell structure. (C) Pathological fluid-based Hematoxylin-eosin staining (HE staining) of the posterior right upper lobe of the lung x400. Significantly increased nucleated cells, scattered cells, evenly distributed, mainly neutrophils (pointed by red arrows), easy to see macrophages (pointed by black arrows), macrophage soma enlarged, round, or circular, it can be seen that macrophages engulf a large number of different sizes, lumpy, or fine, brownish-yellow, brownish-black particles; Macrophages and neutrophils are at different levels of visual field. (D) Pathological HE staining of lung tissue slices x100. Visible lung tissue filled with brownish-yellow or brownish-black particles of varying sizes. (E) Lung tissue section, Prussian blue staining x100. Visible lung tissue cloth granular, lumpy full blue, or blue-black particles, Prussian blue staining positive reaction. (F) Alveolar lavage fluid, transmission electron microscopy x8000. The enlarged macrophage cytoplasm is filled with gray-black iron particles of different sizes and irregular shapes, and the nucleus cannot be seen due to the facet; Marked reduction in organelles may be associated with impaired macrophage immune function. (G) Fibrotic brush sample smear, acid-fast stained. Acid-fast bacilli (pointed by the arrow) can be seen: 6 Bars can be seen in 300 fields (x1000). (H) Alveolar lavage fluid, transmission electron microscopy x50,000. M. tuberculosis (indicated by arrow).
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Regis staining of Bronohoalveolarlavage (BAL) fluid showed macrophages engulfing a large number of brown-black particles of varying sizes ( Figure 2A ). Positive Prussian blue staining ( Figure 2B ), alveolar lavage fluid pathological fluid base, and lung biopsy ( Figures 2C-E ), is composed of substantial iron particles. Under the electron microscope visible macrophage cytoplasm containing large size, structure, irregular iron particles ( Figure 2F ), which are brown-yellow or brown-black with different sizes, metallic luster, and strong refraction. Further acid-fast staining of bronchoscopic brush smears and alveolar lavage fluid showed that acid-fast bacilli were positive (6 in 300 fields) ( Figure 2G ). Acid-fast bacilli were also detected by electron microscopy ( Figure 2H ), biopsy of the posterior right upper lobe of the lung is granulomatous inflammation with necrosis, and the patient was diagnosed with siderosis and TB.