PMC10209443_01
Computed tomography scans and chest radiographs obtained during the course of the patient's illness. (A, D, G) Computed tomography scans obtained at the time of the first visit to our hospital showed consolidation in the right upper lobe (A, black arrow) and multiple subpleural bullae (D, black arrow) with mild pleural fibrosis and subpleural atelectasis. A chest radiograph showed elevation of the right hilum (G, black arrow) caused by the reduced volume of the right upper lobe. (B, E, H) Images obtained 2 years after the first visit. Computed tomography scans showed extensive reductions in the volume of the upper lobes on both sides (B, E), and a chest radiograph showed traction on the trachea (H, black arrow). (C, F, I) Images taken 5 years after the first visit. Computed tomography scans revealed a cavity in the apex of the right lung (C, black arrow) with consolidation extending to the right lower lobe (F, black arrow). A chest radiograph showed a marked reduction in lung volume with mild cardiomegaly (I).
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However, chest imaging revealed pleural or subpleural fibrosis with multiple and subpleural cysts, mild elevation of the hilum, and consolidation in the apical regions of both lungs, which were more marked on the right than on the left (Fig. 1A, D, 1G). Two years later, after a second referral with a complaint of dyspnea, both upper lung lobes were reduced in volume on his chest images (Fig. 1B, E, 1H). Aspergillus precipitating antibody positivity, and right heart failure on transthoracic echocardiography. A computed tomography scan of the chest obtained during the final admission showed a platythorax with a marked reduction in the size of the upper lobes of both lungs and cavitary lesions (Fig. 1C, F, 1I).
Micrograph of lung specimens stained with hematoxylin-eosin, Elastica van Gieson (A-B) Micrographs of lung specimens stained with hematoxylin-eosin (HE) and Elastica van Gieson methods. (A) Marked fibroelastosis with collapse, traction bronchiectasis, and pleural fibrosis in the lingula (Elastica van Gieson staining, x20, scale bar 0.5mm). (B) Tiny cavities surrounded by fibrosis (Elastica van Gieson staining, x10, scale bar 1mm) and Hyphae-like structures (arrow) and brown colored spores (arrowhead) were found in the necrotic tissue in the cavities (Fig. 2B inset) (HE staining, x400, scale bar 50 mum). (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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Histopathologically, subpleural atelectatic indurations composed of marked fibroelastosis with collapse and traction bronchioloectasis were seen in the left upper lobe (Fig. 2A). Near the large cavity of the right upper lobe, there were tiny cavitary lesions surrounded by fibrosis (Fig. 2B). Hyphae-like structures (arrow) and brown colored spores (arrowhead) were found in the necrotic tissue in the cavities (Fig. 2B inset) and Aspergillus niger was suspected.
Micrograph of lung specimens stained with anti-FBN2 antibody. (A-B) Anti-FBN2 antibody staining using IHC revealed more intense expression of FBN2 antigen in the lung parenchyma from our case (B) than in control lung tissue (A) (anti-FBN2 antibody, IHC, x60). Scale bar, 100 mum.
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By IHC staining for FBN2 antigen with an FBN2 antibody according to a previous report, compared to the control lung obtained from non-cancerous and autopsied lung tissues from a patient with the pancreatic cancer, the FBN2 antigen was intensely identified in this case of autopsied lung parenchyma (Fig. 3A and B).
Morphological analysis of the features of elastic and reticular fibers. Morphological analysis of the elastic and reticular fibers using specific staining (A, B, C, D).The increases elastic fibers in lung tissue from our patient were thickened, wavy, frayed and hazy (B) in comparison with those in the control lung tissue (A) (resorcin-fuchsin staining, x60). Reticular fibers were sparse and had a disorganized structure (D) compared with those in the control lung tissue (C) (silver staining, x60). Scale bar, 100 mum.
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Additionally, elastic fibers were seen on microscopy with resorcin-fuchsin staining as thickened, wavy, frayed, and granular compared to the control lung (Fig. 4A and B). The reticular fibers were sparse and did not have a typical mesh-like structure as observed by silver staining in the whole lung parenchyma compared to the control lung (Fig. 4C and D).