pulmonary nodular lymphoid hyperplasia

Pulmonary

nodular lymphoid hyperplasia in a 53-year-old man with malignant sign: a case report. The CT scan of the patient. a Initial CT scan performed in July 2017. b Follow-up CT scan performed in November 2018. c Follow-up CT scan performed March 2019. d The three-dimensional reconstruction of CT scan performed in March 2019

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Pulmonary nodular lymphoid hyperplasia (PNLH) is a type of benign lymphoproliferative disease that can affect the lung.

Epidemiology

It can present in any age group although the majority of cases present between 50 and 70 years of age .

Clinical presentation

Most cases are usually asymptomatic and found incidentally on imaging for an unrelated cause. Occasionally, there can be symptoms such as shortness of breath, cough and/or pleuritic chest pain.

Pathology

Most, if not all, such cases are favored tp represent extranodal marginal zone B-cell lymphomas masquerading as reactive lesions.

There is usually dense nodular infiltration of mature, polyclonal lymphocytes and plasma cells with multiple reactive germinal centers. These are sharply demarcated from surrounding parenchyma and with central areas of scarring. Foci of organizing pneumonia may be commonly seen in the periphery. There can also be mild, local lymphangitic spread of lymphocytes permeating into the perivascular interstitium.

Associations

Sjögren syndrome

Radiographic features

CT

Usually present as a solitary lesion. Described features on HRCT chest include :

well-circumscribed nodular lesion: this can be a solitary pulmonary nodule or focal consolidation with an ~2 cm diameter
coalescence of two or more nodules can rarely occur to form a discrete mass
a very mild, focal lymphangitic pattern may be seen

History and etymology

It was initially described as pulmonary pseudolymphoma by S L Saltzstein in 1963 . The term pulmonary nodular lymphoid hyperplasia was suggested by Kradin and Mark .

Differential diagnosis

Imagin differential considerations include

pulmonary lymphoma (especially MALT lymphoma affecting lung)
- nodules tend to be bilateral and multifocal and may show features such as pleural invasion