PMC4976602_01
Chest CT shows diffuse irregular wall thickening at the trachea (A) and bilateral bronchi (B).
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CT examination revealed diffuse irregular wall thickening at the trachea and bilateral bronchi (Fig. 1), atelectasis of the right middle lobe because of right middle bronchial wall thickening, an enlarged lymph node in the left supraclavicular and right axillary area, and splenomegaly. Complete blood counts revealed a white blood cell count of 4800/mm3, a hemoglobin level of 10.8 g/dL, a platelet count of 132,000/mm3, an absolute neutrophil count of 2822/muL (58.8%), and a lymphocyte count of 989/muL (20.6%).
Bronchoscopy shows diffuse irregular surface of the tracheal and bilateral bronchial mucosa and polyposis-like lesions. (A) Trachea. (B) Bronchus of right upper lobe. (C) Bronchus intermedius. (D) Left secondary carina.
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A bronchoscopy revealed diffuse irregular surface of the tracheal and bilateral bronchial mucosa and polyposis-like lesions (Fig. 2).
Pathological findings of endobronchial biopsy. (A) Atypical cells localized at the under of bronchial mucosa (H&E staining, x100). (B) Atypical cells with a high nuclear cytoplasmic ratio and irregular nuclei formed sheet like lesions (H&E staining, x400). (C) Immunohistochemical staining revealed positivity for CD5 (x200). (D) Immunohistochemical staining revealed positivity for Cyclin D1 (x200).
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These morphologic findings were compatible with a low grade lymphoma, such as MCL (Fig. 3A and B). On immunohistochemical staining, these atypical cells were found to be positive for CD5, CD20, CD79a, and Cyclin D1 but negative for CD3, CD10, CD21, and CD138 (Fig. 3C and D).