PMC6077018_01
CT scans of the chest at different levels on lung window (A-D) and mediastinal window (E, F), showing multiple calcific nodules and thin-walled air cysts of variable sizes in all lung zones bilaterally. Consolidations with variable calcifications are present in the right upper lobe posterior segment (arrows in A and B) and in the middle lobe (m in C). A cavity in the right lung base (arrow in E) is noted. Septal thickening was not present on high-resolution chest scans (not shown).
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A high-resolution and conventional CT (Figure 1) of the chest revealed multiple calcific nodules of 0.3 cm to 5 cm size predominantly distributed in the mid-lower lungs subpleurally and peripherally. A cavity with a small fluid level and smooth inner wall was present in the right lower lobe consolidation (Figure 1E).
Whole body technetium MDP bone scans showing multiple nodular areas of increased tracer activity in the lungs bilaterally (arrows).
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A technicium MDP bone scan was requested, revealing no abnormal uptake in the skeleton, but most of the large calcific nodules in the lung did show increased tracer activity mimicking rib metastasis (Figure 2).
The lesion in this microphotograph is predominantly composed of mature plasma cells (arrows). The amorphous material among the plasma cell aggregates corresponds to amyloid (Am) (H&E, 20X).
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The H&E sections (Figure 3) revealed a variable density of plasma cell infiltration and amorphous interstitial substance with focal microcalcifications.
Immunohistochemistry showing positive restricted reactivity for kappalight chain, which is indicated by the dark cytoplasmic staining of the plasma cells (arrows) (immunoperoxidase, 40X).
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The vast majority of plasma cells were positive for a kappa light chain (Figure 4).