Figure 2. Images of the Lungs.
A chest radiograph obtained at the time of admission
to this hospital (Panel A) shows subtle, fine reticulonodular
opacities in both lungs that appear to spare
the costophrenic sulci. An axial CT scan of the chest
(Panel B) shows small, irregular pulmonary nodules
that measure 2 to 3 mm in diameter; some nodules appear
centrilobular in distribution. Several nodules appear
to be cavitating, and there are small central areas
of low attenuation. Small cysts of various sizes are also
seen in both lungs. The small nodules and cysts predominantly
involve the upper and middle zones of the
lungs and appear to spare the lung bases and costophrenic
sulci.
図2. 肺の画像
この病院に入院時に行われた胸部X線（パネルA）には、両肺に希薄な微細網状が見られ、心室間溝を分けているように見える。胸部体軸断層のCTスキャン（パネルB）は、不揃いで直径が2～3ｍｍの肺結節が見られる。いくつかの結節は空洞化しているように見え、低吸収の小さな中央域がある。様々なサイズの小さなのう腫もまた両肺に見られる。小節とのう腫は、主に肺の上部と中部に影響を及ぼしており、肺底部と心室間溝を割いているようにみえる。
This distribution of findings is more apparent
on a reformatted coronal CT image (Panel C).
Figure 3. Photomicrographs of the Scapular-Biopsy Specimen.
There is extensive necrosis (Panel A, hematoxylin and eosin) and prominent acute inflammation. At higher magnification,
neutrophils and histiocytes are seen in a background of necrosis (Panel B, hematoxylin and eosin). Sheets of
cells are seen (Panel C, hematoxylin and eosin), with elongated, grooved nuclei and a higher nuclear-to-cytoplasmic
ratio than is typical of macrophages, features suggestive of Langerhans’ cells. Immunohistochemical stains for
CD1a (Panel D) and langerin (inset) are positive, confirming the diagnosis of Langerhans’-cell histiocytosis.
