Association of Pulmonary Cysts and Nodules in a Young Female Patient

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Association of Pulmonary Cysts and Nodules in a Young Female Patient Olívia Meira Dias, MD, Ellen Caroline Toledo do Nascimento, MD, PhD, Carlos Roberto Ribeiro Carvalho, MD, PhD, Mariana Sponholz Araujo, MD, PhD, Carolina Salim Gonçalves Freitas, MD, Ronaldo Adib Kairalla, MD, PhD, Marisa Dolhnikoff, MD, PhD, Bruno Guedes Baldi, MD, PhD CHEST Volume 149, Issue 6, Pages e183-e190 (June 2016) DOI: 10.1016/j.chest.2016.02.652 Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 1 Skin-colored papules located between the nose and cheeks, which are more prominent on the right side and compatible with angiofibroma (arrow). (The patient provided written consent for the use of this photograph.) CHEST 2016 149, e183-e190DOI: (10.1016/j.chest.2016.02.652) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 2 Chest radiograph presented no abnormal findings. CHEST 2016 149, e183-e190DOI: (10.1016/j.chest.2016.02.652) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 3 A-D, High-resolution CT scan of the chest showing multiple thin-walled pulmonary cysts and scarce solid, noncalcified nodules diffusely distributed in all lung fields. CHEST 2016 149, e183-e190DOI: (10.1016/j.chest.2016.02.652) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 4 A, Proliferation of lymphangioleiomyomatosis (LAM) cells within the wall of a cystic air space (solid arrow) and a micronodule composed of proliferated type II pneumocytes (open arrow) (hematoxylin and eosin [H&E] staining, panoramic view). B-D, Proliferation of spindle-shaped myoid cells (LAM cells) within the wall of a cystic air space: B, H&E staining, ×100; C, LAM cells positive for smooth muscle actin immunostaining, ×100; D, LAM cells focally positive for human melanoma black 45 immunostaining, ×100. E-G, Micronodule composed of proliferated type II pneumocytes: E, H&E staining, ×40; F, H&E staining, high magnification of proliferated type II cells, ×400; G, cytokeratin-7 immunostaining of type II pneumocytes, ×400. CHEST 2016 149, e183-e190DOI: (10.1016/j.chest.2016.02.652) Copyright © 2016 American College of Chest Physicians Terms and Conditions