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. 2021 Mar 30;11:7170. doi: 10.1038/s41598-021-85999-5

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Representative HRCT images with diffuse nodules and small cavitary lesions. This patient was a 33-year-old female with S-LAM. HRCT showed diffuse nodules (arrowheads) and small cavitary lesions (white arrow) (A). Histopathological examination of the lung specimen obtained by VATS demonstrated that these nodules and cavitary lesions were composed of LAM lesions. A loupe view of the resected specimen showed the existence of multiple areas with nodular proliferation of LAM cells in the lung parenchyma (HE stain; arrowheads); each nodule was approximately 1.5 mm in size (B). Note that nodular lesions showed positive immunostaining for α-SMA (arrowheads) (C). The nodules were composed of uniformly proliferating spindle-shaped LAM cells and lined by alveolar epithelium (HE stain, original magnification × 90) (D). The magnified view showed LAM cells with eosinophilic cytoplasm and nuclei devoid of pleomorphism or mitotic activity (HE stain, original magnification × 300) (E). LAM cells showed cytoplasmic positive immunostaining for α-SMA (F: original magnification × 195) and HMB45 (G: original magnification × 300).