PMC6949674_01
Imaging. (a) Pulmonary computed-tomography (CT) scan showing diffuse bilateral infiltrates. (b) CT with intravenous contrast showing enlargement of both kidneys with bilateral renal nodules.
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fig1
Despite appropriate antibiotics and clinical improvement, thoracic CT scans revealed worsened dense infiltrates (Figure 1(a)), pleural effusions, hepatosplenomegaly and nodular lesions of both kidneys (Figure 1(b)).
Histology. (a) Lymphomatous infiltration in the bronchial mucosa (hematoxylin-eosin (HE) staining, x40). (b) Large diffuse large B-cell lymphoma (DLBCL) cells characterized by nuclei with prominent nucleoli on a background of tumoral necrosis (HE, x400). (c) CD20+ labeling of the DLBCL cells. (d) Epstein-Barr virus-encoded RNA-1 expressed by DLBCL cells.
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fig2
A new bronchoscopy with biopsies found CD20+ large lymphomatous cell infiltration (Figure 2) in bronchi. EBV, as assessed by in situ hybridization with an EBV-encoded small RNA probe, was diffusely positive in about 80% of tumor cells (Figure 2).