PMC8041536_01
(a) Coronal sections of computed tomography showing worsening of bilateral lower lobe consolidation along with extensive ground-glass density, interlobular septal thickening. (b) Pathological specimen showing infiltration of lung parenchyma by kappa light chain restricted atypical plasma cells with a large, round to irregular nuclei, variably prominent nucleoli, and moderate amounts of eosinophilic cytoplasm. Flow cytometry showed 17.9% plasma cells with the following immunophenotypic markers (CD5 (-), CD10 (-), CD19 (-), CD20 (-), CD38 (bright+), CD45 (dim+), CD56 (partial dim+), CD138 (variably+), and CD319 (+)) (Hematoxylin and eosin; 20x, 100x, 500x, and 500x, respectively.)
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PMC8041536_01_CRIHEM2021-5590975.001.jpg
fig1
ASCT requiring hospitalization. A computed tomography (CT) at admission showed new bilateral lower lobe infiltrates with consolidation and innumerous pulmonary nodules (Figure 1). A repeat CT scan was performed for persistent hypoxia, which showed further worsening of bilateral lower lobe consolidation along with extensive ground-glass density, interlobular septal thickening, and patchy consolidation throughout the upper lobes as well as superior segments of the lower lobes (Figure 1). Video-assisted thoracoscopy and lung biopsy showed extensive patchy involvement of lung parenchyma by clonal kappa-restricted plasma cells in perivascular, peribronchial, and periseptal distribution in addition to focally forming variably sized aggregates (Figure 1).