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.
この病院への入院時受けた胸部X線検査（パネルA参照）によれば、かすかながら細かい肋骨横隔膜陥を害するように見える網状顆粒状陰影が両肺に見られる。胸部の軸方向CTスキャン（パネルB参照）で、直径2～3ミリの小さな不規則な肺結節が確認できる。その結節の中にはは小葉中心部に分布しているものがある。いくつかの結節は空洞になっているようでわずかな低い弱毒化の中心部がある。また、小さく様々な大きさの嚢胞が両肺に見られる。小さな結節と嚢胞は圧倒的に両肺の上部、中央部に影響を与えていて、両肺底と肋骨横隔膜陥凹を害しているようだ。
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.
