PMC4395825_01
a The tumor lesion before crizotinib administration was mainly necrotic with air-fluid level and had a diameter of about 41 mm, ilo-perihilar right. b After 10 days of crizotinib administration, a CT scan of the chest showed extensive bilateral ground-glass opacities throughout both lungs and a further increase in the solid lesion (excavated), which measured about 60 mm. c After treatment with corticosteroid, a reduction of the ground-glass component occurred bilaterally, while the lesion in the right lower lobe appeared essentially unchanged in morphology and size.
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F1
The high-resolution CT scan revealed the appearance of diffuse extensive bilateral ground-glass opacities involving both lungs (fig. 1a, b). The patient obtained an immediate benefit with improvement of arterial blood gas parameters (PaO2 75 mm Hg without oxygen), and a CT scan after 2 weeks showed a partial remission of the disease (fig. 1c).
Diffuse invasive aspergillosis observed in autopsy lung tissue (HE x400).
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F2
Histological evaluation of autopsy lung tissue showed areas of interstitial organizing fibrosis, carcinomatous lymphangitis and, more importantly, fungal hyphae consistent with aspergillus spp. invading alveoli and vessels (fig. 2) with areas of ischemic necrosis (invasive aspergillosis).