1. A 68-Year-Old Man With Dyspnea on Exertion and Cough
Abhinav Agrawal, MD, Rutuja R. Sikachi, MBBS, DNB (Anesthesia), Seth Koenig, MD, FCCP, Sameer Khanijo, MD 
CHEST 
Volume 153, Issue 6, Pages e139-e145 (June 2018)
DOI: /j.chest
Copyright © 2018 American College of Chest Physicians Terms and Conditions

2. Figure 1
CT scan of the chest showed scattered areas of mucoid inspissation and narrow airways (white arrow) and nodularity in all lobes with predominant tree-in-bud opacities (black arrows) in the right upper, middle, and lower lobes. The coronal images show some dilated airways.
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3. Figure 2 Flow spirometry demonstrating an obstructive pattern.
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4. Figure 3
The biopsy from right middle lobe showed diffuse infiltration by monotonous small atypical lymphocytes in the lung parenchyma with clumped nuclear chromatin and inconspicuous nucleoli. No atypical mitosis or atypia seen. Normal lung parenchyma without infiltration is also seen. H&E = hematoxylin and eosin.
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5. Figure 4
Immunostains showed that the atypical cells were positive for CD20, CD79a, CD5, and CD23 (dim intensity).
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Copyright © 2018 American College of Chest Physicians Terms and Conditions