June Case of the Month Clinical History:
A 30-year-old man with a remote history of HIV/AIDS, subsequently lost to follow up presented with a 3-week history of sore throat and coughing with occasional hemoptysis. Physical exam was normal. Chest CT scan showed innumerable bilateral pulmonary nodules 6-9 mm in size (Figure 1). A transbronchial biopsy of the right lower lobe was performed for further evaluation. Microscopically, there were multiple pieces of unremarkable lung parenchyma with only two pieces involved by a monotonous, low-grade spindle cell proliferation with focal fascicular growth pattern (Figure 2). The lesional process also formed vascular spaces, with some having a “slit-like” appearance containing extravasated red blood cells (Figure 3). Rare cytoplasmic hyaline globules were seen. No organizing pneumonia or granulomas were identified. GMS and AFB special stains were negative for fungi and acid-fast organisms, respectively. Immunohistochemical stains showed that the spindle cell proliferation was positive for D2-40 (Figure 4), ERG (Figure 5), and CD34 (focal and weak), while negative for pan-CK and CD68. The spindle cells were positive for HHV-8 in a nuclear speckled pattern (Figure 6). CMV immunostaining was negative.
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A 30-year-old man with a remote history of HIV/AIDS, subsequently lost to follow up presented with a 3-week history of sore throat and coughing with occasional hemoptysis. Physical exam was normal. Chest CT scan showed innumerable bilateral pulmonary nodules 6-9 mm in size (Figure 1). A transbronchial biopsy of the right lower lobe was performed for further evaluation. Microscopically, there were multiple pieces of unremarkable lung parenchyma with only two pieces involved by a monotonous, low-grade spindle cell proliferation with focal fascicular growth pattern (Figure 2). The lesional process also formed vascular spaces, with some having a “slit-like” appearance containing extravasated red blood cells (Figure 3). Rare cytoplasmic hyaline globules were seen. No organizing pneumonia or granulomas were identified. GMS and AFB special stains were negative for fungi and acid-fast organisms, respectively. Immunohistochemical stains showed that the spindle cell proliferation was positive for D2-40 (Figure 4), ERG (Figure 5), and CD34 (focal and weak), while negative for pan-CK and CD68. The spindle cells were positive for HHV-8 in a nuclear speckled pattern (Figure 6). CMV immunostaining was negative.
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