PMC5066297_01
(a) CT scan with contrast revealed a 3 cm right lower lobe paravertebral lesion extending across the T5 and T6 vertebral levels and invading into the adjacent pleural surface (arrow) (b) MRI revealing a right paravertebral mass (arrow).
gr1.jpg
PMC5066297_01_gr1.jpg
fig1
A MRI of the chest was performed revealing a right paravertebral mass (Fig. 1b). The CT confirmed a 3 cm right lower lobe paravertebral soft tissue density mass lesion, invading into the adjacent pleural surface (Fig. 1a).
IgG4-related lung disease photomicrographs (a) Heavily inflamed lung parenchyma (Hematoxylin-eosin stain, original magnification,x25) (b,c) Dense lymphoplasmacytic inflammatory infiltrate within the lung parenchyma (Hematoxylin-eosin stain, original magnification in b, x100; and in c,x200) (d) Focus of obliterative phlebitis (Hematoxylin-eosin stain, original magnification, x200).
gr2.jpg
PMC5066297_01_gr2.jpg
fig2
With reference to the microscopic description, sections of lung parenchyma and adjacent fibrous tissue showed a dense lymphoplasmacytic infiltration predominantly located in the lung parenchyma (Fig. 2a, b, c). Within the lung parenchyma there were foci suggested but not diagnostic for obliterative phlebitis (Fig. 2d).
Immunohistochemistry shows that the inflammatory infiltration is predominantly composed of (a) CD138 positive plasma cells along with moderate amount of (b) CD3 positive T-lymphocytes and scattered (c) CD20 positive B-lymphocytes. Most plasma cells were noted to express (d) IgG and a large proportion of these plasma cells are also noted to co-express (e) IgG4. (f) CK7 and (g) TTF-1 highlight the pulmonary parenchymal architecture which was in areas distorted due to marked inflammatory component.
gr3.jpg
PMC5066297_01_gr3.jpg
fig3
Immunohistochemistry performed showed (Fig. 3) that the inflammatory infiltration was predominantly composed of CD138 (Fig. 3a) positive plasma cells along with moderate amount of CD3 positive T-lymphocytes and scattered CD20 positive B-lymphocytes (Fig. 3d). Most plasma cells were noted to express IgG (Fig. 3b) and a large proportion of these plasma cells are also noted to co-express IgG4 (Fig. 3c). CK7 and TTF-1 highlight the pulmonary parenchymal architecture which was in areas distorted due to marked inflammatory component (Fig. 3f and g).