Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Follicular bronchiolitis
- Radiologic Findings
- Fig. 1. Ill-defined peribronchial infiltrations and nodular lesions in both lungs, mainly demonstrating upper lobe dominancy
Fig. 2-4. Diffuse ill-defined, fuzzy centrilobular nodules with with bronchial wall thickening in both lungs, predominant in both upper lobes, while relatively sparing of cardiophrenic areas.
Right upper and lower lobes, wedge resection
- Peribronchiolar lymphoplasmacytic infiltration with prominent follicle formation, consistent with follicular bronchiolitis.
- Brief Review
- Follicular bronchiolitis is a lymphoproliferative disease, usually of reactive and non-neoplastic etiology. It results mostly from hyperplasia of bronchial associated lymphoid tissue or BALT. It is more prominent in middle aged and elderly patients. Secondary causes include connective tissue disease, a state of immunodeficiency, autoimmune disease, and infections. Regarding histopathology, follicular bronchiolitis demonstrates hyperplastic lymphoid follicles with reactive germinal center along bronchovascular bundles, narrowing or obliterating bronchiolar lumen. Such findings may show extension along the interlobular septa with sparing of the alveolar septa. Immunohistochemistry of follicular bronchiolitis also shows CD20 and CD79a positivity with predominant B cell infiltrations within the peribronchial follicles.
With regards to the imaging of follicular bronchiolitis, chest X-rays are often negative in early cases. Lung hyperinflation due to air trapping, small nodules, reticular or reticulonodular infiltrations may be noted in moderate to severe cases. On HRCT, bilateral 1~3mm tiny centrilobular nodules with peribronchial distribution are commonly noted. Characteristically, nodules may demonstrate a fluffy tree-in-bud (or cotton-in-bud) appearance. Disease is limited to the airways and diffuse interstitial involvement is extremely rare. Treatment usually includes steroid and/or macrolide antibiotics for idiopathic cases, while removal of the causative antigen is the key to treatment of secondary cases.
- References
- 1. Basheer Tashtoush, Ndubuisi C. Okafor, Jose F. Ramierz, et al. Follicular Bronchiolitis: A Literature Review. J Clin Diagn Res. 2015
2. Pipavath SJ, Lynch DA, Cool C, et al. Radiologic and Pathologic Features of Bronchiollitis. AJR 2005
3. Sarah J, Howling David. Follicular Bronchiolitis: Thin-section CT and Histologic Findings. Radiology 1999
- Keywords
- lung, bronchiolitis, lymphoproliferative disease,