대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Nodular lymphoid hyperplasia

Radiologic Findings

CT scans show an irregular shaped mass with an air-bronchogram in the right lower lobe. Multiple small, well-defined, solid nodules are also noted. These small nodules showed no interval change since CT taken on 2011-11-16, however the irregular-shaped mass is shown to have slowly increased in size. Percutaneous transthoracic needle biopsy was performed and pathology confirmed nodular lymphoid hyperplasia (NLH).

Brief Review

Nodular lymphoid hyperplasia had initially been referred to as pseudolymphoma in 1963 by Saltzstein. However, this concept fell into disrepute with the discovery of a marginal zone lymphoma of MALT (mucosa associated lymphoid tissue) origin. Thus, since 1983, the term nodular lymphoid hyperplasia has been used to describe these lesions as first suggested by Kradin and Mark. Median age at presentation is 65 years (age range, 19–80 years), with an even sex distribution. NLH is typically asymptomatic and is found incidentally on imaging studies. NLH is characterized by a dense nodular infiltration of mature, polyclonal lymphocytes and plasma cells with multiple reactive germinal centers, sharply demarcated from the surrounding parenchyma, with central areas of scarring. Mild, local lymphangitic spread of lymphocytes may also be present, permeating into the perivascular interstitium. NLH has been described most commonly as a solitary lesion, although multiple pulmonary nodules can also be observed. It can also manifest with focal consolidation and may regress or remain stable for years. The incidence of NLH is rare whereas MALT lymphoma is relatively common. Importantly, as the natural history of NLH has not yet been well described, biopsy-proven patients with multiple persistent lesions usually undergo continued surveillance scans for a considerable time after its initial diagnosis.

References

1. S S HARE, C A SOUZA, G BAIN, J M SEELY, M M GOMES, M QUIGLEY, et al.The radiological spectrum of pulmonary lymphoproliferative disease.Br J Radiol. 2012 Jul;85(1015):848-64.
2. Rogoziński P, Bruliński K, Malinowski E, Wandzel P, Kucharzewski M, et al. Nodular lymphoid hyperplasia - a rare case of lymphoproliferative disorder of the lungs. Pneumonol Alergol Pol. 2013;81(1):68-72.
3. Song MK, Seol YM, Park YE, Kim YS, Lee MK, Lee CH, et al. Pulmonary nodular lymphoid hyperplasia associated with Sjögren's syndrome. Korean J Intern Med. 2007 Sep;22(3):192-6.

Keywords

Lung, Lymphproliferative disorder,