gastrointestinale noduläre lymphoide Hyperplasie

School ager
with intermittent abdominal pain. Spot images from an upper GI small bowel follow through show multiple round filling defects, which represent pseudopolyps, throughout the terminal ileum which is normal in caliber.The diagnosis was lymphoid hyperplasia.
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Gastrointestinal
nodular lymphoid hyperplasia • Gastrointestinal nodular lymphoid hyperplasia - Ganzer Fall bei Radiopaedia
Morgan M, Gastrointestinal nodular lymphoid hyperplasia. Case study, Radiopaedia.org (Accessed on 09 Feb 2023) https://doi.org/10.53347/rID-44344 • CC by-nc-sa 3.0 (modified)
Diffuse
duodenal nodular lymphoid hyperplasia: a large cohort of patients etiologically related to Helicobacter pyloriinfection. Diffuse Duodenal Nodular Lymphoid Hyperplasia. 35 year male presented with epigastric pain, vomiting and weight loss of 5 kg over the past 6 months. Duodenal composite images. Top left image: Duodenal bulb revealed smooth mucosa without any nodular lesion. Top right and 2 bottom images: post-bulbar region, second and third part of duodenum showed diffuse numerous mucosal nodules (>5 mm size each) scored as grade 4 disease. There was complete loss of Kerckring"s folds. Duodenal biopsies revealed nodular lymphoid hyperplasia. Immunoglobulin revealed mild elevation of IgG level [IgG 2090 mg/dl (normal 700-1600 mg/dl); IgM. 120 mg/dl (normal = 40-230 mg/dl); IgA 145 mg/dl (normal = 70-400 mg/dl)].
bmcgastroenterol.biomedcentral.com • CC-by-2.0
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Gastrointestinal nodular lymphoid hyperplasia is a type of nodular lymphoid hyperplasia that can be found elsewhere in the body. It is formed out of gut-associated lymphoid tissue (GALT), and most often is a diagnostic dilemma for radiologists in the stomach and terminal ileum.

Pathology

Gut-associated lymphoid tissue (GALT) is a subset of the larger class of mucosa-associated lymphoid tissue (MALT), and it underlies the acquired immune system in the gastrointestinal tract.

GALT is formed from lymphoid aggregates in the mucosa, including lymphoid follicles and lymph nodes. Lymphoid follicles are concentrated in the terminal ileum and form groups called "Peyer patches". The epithelium above these follicles is involved with complex responses to antigens it encounters in the small bowel.

The concentration of lymphoid tissue in the terminal ileum also explains why small bowel lymphoma has a predilection for the site.

Radiographic features

Enlarged lymphoid follicles are within normal limits for young adults, which often is the same population that is evaluated for new-onset Crohn disease.

Fluoroscopy
Small bowel follow through
  • terminal ileum
    • multiple discrete, 1-3 mm nodules along the mucosal surface
    • nodules should not be confluent
    • small bowel folds should be normal-appearing

Differential diagnosis

  • normal variant: if a few prominent nodules are found in the terminal ileum of a young person
  • immunodeficiency / CVID: can be considered if a much greater than normal number of nodules are found
  • lymphoma: if mucosal nodularity is larger, more confluent, and more irregular
  • if small bowel folds are abnormal, one should consider
Siehe auch:
Assoziationen und Differentialdiagnosen zu gastrointestinale noduläre lymphoide Hyperplasie:
noduläre
lymphoide Hyperplasie
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