PMC9195108_01
PET-CT showing faintly FDG avid peribronchial ground glass opacities, right upper and lower lobe consolidation and diffusely abnormal bone marrow activity throughout the skeleton including multifocal uptake at the long bones of the lower extremities.
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Ab, ANCA, anti-MPO Abs, anti-proteinase 3 Abs, and SPEP were unremarkable as were findings on both bone marrow biopsy and flow cytometry of peripheral blood. A PET-CT reported diffusely abnormal bone marrow activity, increased throughout the axial skeleton and long bones, suggesting both a markedly stimulated bone marrow pattern and a diffuse marrow replacement disorder (Fig. 1).
Hematoxylin and eosin (H/E) staining highlighting pulmonary blood vessels distended by intravascular collection of malignant lymphocytes.
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Immunohistochemistry on the lung (Figs. 2 and 3) demonstrated positive results for CD20, CD5, BCL-2 as well as BCL-6; negative for CD3, CD10, CD30, CD34, BCL-1, Mum-1 and Alk-1.
Immunohistochemistry staining demonstrating (a) tumor cells and (b) vessel walls.
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Immunohistochemistry on the lung (Figs. 2 and 3) demonstrated positive results for CD20, CD5, BCL-2 as well as BCL-6; negative for CD3, CD10, CD30, CD34, BCL-1, Mum-1 and Alk-1.