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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 ground-glass attenuation. This patient was a 33-year-old female with S-LAM. HRCT showed diffuse nodules with diffuse ground-glass attenuation areas (A). She underwent lung biopsy by VATS to establish the diagnosis. Macroscopic view of the resected specimen showed brown-colored lung tissue with a few cystic lesions (B). Histopathological examination demonstrated numerous hemosiderin-laden macrophages in alveolar spaces and mild thickening of the alveolar walls with hemosiderin deposition in the interstitium (C: HE stain, original magnification × 192). Bundles of proliferating LAM cells with slit-like spaces were also found in the lung parenchyma (D: HE stain, original magnification × 162). LAM cells showed cytoplasmic positive immunostaining for α-SMA (E: original magnification × 195) and HMB45 (F: original magnification × 300).