PMC4904558_01
(a) Computed tomography scan of the chest, showing widespread pulmonary changes, including multiple thin-walled cystic air spaces (single arrow), scattered foci of consolidation (arrowhead), and interlobular septal thickening (double arrow). Radiologic findings were most suggestive of lymphoid interstitial pneumonia, but lymphoma could not be excluded. (b) Computed tomography scan of the chest demonstrating enlarged hilar nodes.
CRJ2016-7056035.001.jpg
PMC4904558_01_CRJ2016-7056035.001.jpg
fig1
A computed tomography (CT) scan of the chest (Figure 1(a)) demonstrated bilateral widespread abnormalities with basal predominance, including multiple thin-walled cystic air spaces, patchy ground-glass opacities, scattered foci of consolidation, some interlobular septal thickening, and a trace right pleural effusion. There were enlarged hilar lymph nodes up to 1.5 cm in size (Figure 1(b)).
(a) Hematoxylin and eosin-stained lung wedge biopsy showing nodular and interstitial lymphoid infiltrates. Nodule (arrow head) interstitial infiltrate (arrow) (original magnification x20). (b) Hematoxylin and eosin-stained lung wedge biopsy showing benign germinal centre (arrow) (original magnification x1000). (c) Hematoxylin and eosin-stained lung wedge biopsy showing atypical lymphoplasmacytic infiltrate around bronchovascular bundle, around blood vessel (arrow head), and around bronchioles (arrow) (original magnification x100). (d) Hematoxylin and eosin-stained lung wedge biopsy showing atypical small lymphoid cells within the nodular infiltrate (original magnification x400).
CRJ2016-7056035.002.jpg
PMC4904558_01_CRJ2016-7056035.002.jpg
fig2
The biopsy revealed florid lymphoplasmacytic hyperplasia most suggestive of an LIP pattern related to her autoimmune diseases (Figures 2(a)-2(d)).