대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Nodular lymphoid hyperplasia

Radiologic Findings

Chest PA shows a nodular opacity in the left middle lung field (Fig. 1). Nonenhanced CT with mediastinal window setting shows an about 1.2 cm sized well-defined soft tissue density nodule (Fig. 2-1), and contrast-enhanced CT shows homogenous enhancement of the nodule (Fig. 2-2). Chest CT with lung window setting shows multiple variable sized nodules (Fig. 2-3, 4, 5). PET-CT shows mildly hypermetabolic lesion (SUVmax 2.7) in the left lower lobe and multiple small nodular lesions with mild FDG uptake in both lungs (Fig. 3).

Wedge resection was performed for the lung nodule in left lower lobe, and the pathologic diagnosis was nodular lymphoid hyperplasia.

Brief Review

Pulmonary nodular lymphoid hyperplasia (NLH) is a benign, localized, reactive polyclonal lymphoproliferative lesion with unclear etiopathogenesis. This term was first suggested in 1983 by Kradin and Mark to describe one or more nodules or localized lung infiltrates consisting of a reactive lymphoid proliferation. The concept of reactive localized masses of lymphoid tissue in lung, also termed “pseudolymphoma”, was initially proposed in 1963 by Saltzstein to explain the low histologic grade, presence of numerous lymphoid follicles, and benign clinical course of most lung lymphoid proliferations.
Little is known about incidence or natural history of pulmonary NLH, as it is a relatively rare entity. The median age at presentation is 65 years (range 19–80 years), with an even sex distribution. NLH is usually asymptomatic and found incidentally on imaging studies (70%).
Histopathology of NLH is characterized by a dense nodular infiltration of mature, polyclonal lymphocytes and plasma cells with multiple reactive germinal centres, sharply demarcated from surrounding parenchyma and with central areas of scarring.
The most frequent radiographic finding of NLH is a solitary pulmonary nodule. Multiple lesions have been present in 36% of patients. On chest radiograph, lesions are either discrete nodules or ill-defined nodular opacities. Air-bronchograms are often seen. On multidetector CT, lesions are well-circumscribed nodules (solitary pulmonary nodule or focal consolidation) with average diameter of 2 cm (range 0.6–6 cm). Occasionally, 2–3 nodules coalesce to form a discrete mass and very mild, focal lymphangitic spread may be seen. In many instances, preoperative diagnosis is difficult and surgical confirmation is necessary.

Please refer to

Case 753, Case 911,

References

1. Hare SS, Souza CA, Bain G et-al. The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol. 2012;85 (1015): 848-64.
2. Kajiwara S, Sakai S, Soeda H et-al. Multifocal nodular lymphoid hyperplasia of the lung. J Thorac Imaging. 2005;20 (3): 239-41.
3. Abbondanzo SL, Rush W, Bijwaard KE et-al. Nodular lymphoid hyperplasia of the lung: a clinicopathologic study of 14 cases. Am. J. Surg. Pathol. 2000;24 (4): 587-97.

Keywords

Lung, Lymphproliferative disorder,