Figures
- FIGURE 1
a–c) Pulmonary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. Contrast-enhanced computed tomography scan in lung and mediastinal window settings reveal multiple bilateral solid nodules (arrows) and mass-like consolidations (arrowheads) with irregular margins and surrounding ground-glass opacities, suggestive of lymphangitic spread in a, b) the right paramediastinal and c) left perihilar region.
- FIGURE 2
Pulmonary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. a) Diffuse infiltration of a lymphocytic infiltrate of small lymphocytes with scattered follicles (haematoxylin and eosin; 12.5×). b) The lymphoma invades adjacent structures, including airways (arrow), a feature that distinguishes this infiltrate from a benign reactive inflammatory infiltrate (haematoxylin and eosin; 100×). c) The malignant cell population consists of small lymphocytes with clear spaces between adjacent cells, so-called centrocytic-like features. Larger nuclei and plasmacytoid cells may also be seen (haematoxylin and eosin; 400×).
- FIGURE 3
Lymphomatoid granulomatosis. Computed tomography scans a) at and b) below the carinal bifurcation level demonstrates multiple bilateral angiocentric and peribronchovascular lung nodules.
- FIGURE 4
Lymphomatoid granulomatosis. a) Large, subpleural nodule with prominent necrosis (arrow) (haematoxylin and eosin; 12.5×). b) Pleomorphic lymphoid population invades pulmonary artery (arrow) and adjacent airway (haematoxylin and eosin; 40×).
- FIGURE 5
Post-transplant lymphoproliferative disorder. Computed tomography images shows multiple randomly distributed solid nodules in all lung lobes of a young male patient with renal transplant in the past 12 months.
- FIGURE 6
Post-transplant lymphoproliferative disorder (PTLD), high-grade (monomorphic) type. a) Large, subpleural lymphoid nodule with invasion into the overlying pleura (haematoxylin and eosin; 12.5×). b) Lymphoid infiltrate has large cells with areas of marked cytological atypia and mitoses, consistent with a high-grade PTLD (haematoxylin and eosin; 200×).
- FIGURE 7
a–c) Diffuse large B-cell lymphoma. Computed tomography scans in two different patients. a, b) Solid mass with central areas of necrosis and cavitation in the right supra-hilar region resulting in right upper lobe atelectasis. c) Part-solid nodule in the left lower lobe with peripheral lymphangitic spread.
- FIGURE 8
Diffuse large B-cell lymphoma. a) Lymphoid nodule with marked necrosis invading bronchovascular area (haematoxylin and eosin; 20×). b) Histological features indistinguishable from high-grade post-transplant lymphoproliferative disorder (haematoxylin and eosin; 200×).
- FIGURE 9
a, b) Epithelioid haemangioendothelioma. Computed tomography lung images demonstrate a) innumerable bilateral perivascular nodules. b) Coronal reformatted soft-tissue images also show multiple hepatic low-density lesions with nodular peripheral enhancement suggesting haemangiomas (arrow).
- FIGURE 10
Epithelioid haemangioendothelioma. a) Bland, epithelioid cells within an eosinophilic matrix and rare lumina in cytoplasm (arrow) (haematoxylin and eosin; 40×). b) Cells have epithelioid morphology and many have prominent intracytoplasmic vacuole consistent with lumina formation (arrow) (haematoxylin and eosin; 200×).
- FIGURE 11
Kaposi's sarcoma. Computed tomography images shows characteristic ill-defined peribronchovascular small nodules, patchy peribronchial consolidations (flame shaped), interlobular septal thickening and mild ground-glass opacities in both lungs with mid and lower zone predominance.
- FIGURE 12
Kaposi's sarcoma. a) Spindle cell proliferation surrounding bronchovascular area with areas of haemosiderin pigment present in the peripheral lung (haematoxylin and eosin; 20×). b) Atypical spindle cells line vascular space with red blood cells (haematoxylin and eosin; 200×).
- FIGURE 13
Angiosarcoma. Contrast-enhanced computed tomography scan, axial and coronal reformatted images in a 74-year-old male demonstrate multiple, randomly distributed bilateral lung nodules of varying sizes with ground-glass halo (arrow), felt to represent perilesional alveolar haemorrhage. Interestingly, most nodules demonstrated central vascular enhancement on mediastinal windows (not shown).
- FIGURE 14
Angiosarcoma. Malignant epithelioid cells with scattered areas of vascular spaces (haematoxylin and eosin; 100×).
- FIGURE 15
Diffuse idiopathic neuroendocrine cell hyperplasia. Axial computed tomography images demonstrate multiple ≤5 mm nodules (arrows) with subtle “mosaic pattern” of lung attenuation suggestive of air-trapping.
- FIGURE 16
Diffuse idiopathic neuroendocrine cell hyperplasia. a) Neuroendocrine cell proliferation (arrow) present within a small airway with definitive extension beyond the basement membrane (haematoxylin and eosin; 20×). b) Immunohistochemical study of chromogranin highlights diffuse, strong staining of neuroendocrine cells (anti-chromogranin antibody; 40×). c) Aggregate of neuroendocrine cells forming 5-mm nodule, consistent with tumourlet formation (haematoxylin and eosin; 40×). d) Diffuse, strong staining of tumourlet for chromogranin (anti-chromogranin antibody; 40×).
- FIGURE 17
Minute pulmonary meningothelial-like nodules. Computed tomography images reveal multiple micronodules (<3 mm) in both lungs (arrows).
- FIGURE 18
Minute pulmonary meningothelial-like nodules. a) Single lesion centred around a small venule in a thoracoscopic biopsy with multiple lesions (haematoxylin and eosin; 40×). b) Lesional cells have bland cytological features and a whorled “zellballen”-like architecture (haematoxylin and eosin; 200×).
- FIGURE 19
Spectrum of lung adenocarcinoma. a–c) Low-grade, indolent adenocarcinoma. a) Initial high-resolution computed tomography (HRCT) image reveals a 5-mm ground-glass nodule in the left upper lobe that could represent atypical adenomatous hyperplasia or adenocarcinoma in situ (arrow). b) Follow-up HRCT after 5 years demonstrates increase in overall nodule size with a new <5 mm solid component, which suggests progression to minimally invasive adenocarcinoma. c) Fiducial marker was placed prior to surgical resection. d, e) Progression of minimally invasive adenocarcinoma to invasive adenocarcinoma. Note, 27 mm part-solid nodule in the right upper lobe with central <5 mm solid component (arrowhead) suggestive of minimally invasive adenocarcinoma and adjacent subcentimetre ground-glass nodule (arrow) presumed atypical adenomatous hyperplasia or inflammatory (d). e) HRCT at 2 years follow-up shows increase in size and attenuation of the part-solid nodule and growth of its solid stromal component, consistent with progression to invasive adenocarcinoma. The previously seen small, pure ground-glass nodule, which was likely inflammatory, has resolved.
- FIGURE 20
Adenocarcinoma in situ. a) Malignant glandular epithelium present on alveolar surface without evidence of invasion into the underlying lung (haematoxylin and eosin; 12.5×). b) Malignant glandular epithelium characterised by hyperchromatic nuclei with mild to moderate cytological atypia covers the alveolar surface (haematoxylin and eosin; 100×).
Tables
- TABLE 1
Classification system based on the cells of origin of multiple synchronous lung nodules
Lymphoproliferative disorders MALT lymphoma Lymphomatoid granulomatosis Post-transplant lymphoproliferative disorder Diffuse large B-cell lymphoma Vascular tumours Epithelioid haemangioendothelioma Kaposi's sarcoma Angiosarcoma Neuroendocrine cell line Diffuse idiopathic neuroendocrine cell hyperplasia Meningothelial cell line Minute pulmonary meningothelial-like nodules Epithelial cell line Atypical adenomatous hyperplasia Adenocarcinoma in situ MALT: mucosa-associated lymphoid tissue.
