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Weekly Chest CasesArchive of Old Cases

Case No : 974 Date 2016-06-27

  • Courtesy of Young Jin Yoo, Eun Young Kim, Joo Sung Sun, Kyung Joo Park / Ajou University Hospital
  • Age/Sex 34 / F
  • Chief ComplaintIncidental finding of multifocal ground glass opacities in the lungs
  • Figure 1

Diagnosis With Brief Discussion

Diagnosis
Nodular lymphoid hyperplasia (NLH)
Radiologic Findings
Chest CT in 2015 demonstrates, multifocal round to oval shaped, peribronchial and subpleural ground glass opacities in both lungs. Follow-up chest CT after 1 year shows that the lesions have increased slightly. VATS for wedge resection was done. Immnumohistopathologic examination revealed follicular lymphoid hyperplasia with interfollicular lymphoplasmacytosis, consistent with nodular lymphoid hyperplasia (CD3, CD20: Positive, Kappa, Lambda: Focal positive, Bcl-2: Negative).
Brief Review
Nodular lymphoid hyperplasia (NLH) is a non-neoplastic primary lymphoid lesion of the lung. Reactive (non-neoplastic) lymphoid lesions of the lung could be classified based on the pattern of pulmonary involvement as follows: nodular lymphoid hyperplasia (focal); follicular bronchiolitis (peribronchial); lymphoid interstitial pneumonia (diffuse with pulmonary cyst). NHL was initially described by Saltzstein in 1963 and categorized by Kradin and Mark in 1983, and formerly referred to as pseudolymphoma. NHL shows histopathologic findings of localized infiltration of polyclonal lymphocytes (predominantly T cells). NLH is a nodular and well-circumscribed lymphoproliferative mass with a modest amount of fibrosis present between the lymph follicles. Germinal centers lack follicular colonization and are bcl-2-negative, indicating polyclonal and reactive proliferation Radiographic findings of NHL include nodule, mass, mass-like consolidation, or ground glass opacities (single or multiple). In the index case, there are multiple bilateral ground glass opacities on chest CT. The differential diagnosis includes primary pulmonary lymphoma and lung cancer.
References
1. A Case of Pulmonary Nodular Lymphoid Hyperplasia with a Resected Cavity, followed by Spontaneous Regression of the Remaining Lesions, Inter Med 49: 1617-1621, 2010
2. Non-neoplastic pulmonary lymphoid lesions, Thorax 2001;56:964–971
3. Nodular lymphoid hyperplasia: rare case of lymphoproliferative disease in the lung, Gen Thorac Cardiovasc Surg (2009) 57:324–327
4. Follicular bronchiolitis: A Literature Review Journal of Clinical and Diagnostic Research. 2015 Sep, Vol-9(9): OE01-OE05
5. Primary pulmonary lymphoid lesions: Radiologic and pathologic findings RadioGraphics 2016; 36:53–70
Keywords
Lung, Lymphproliferative disorder,

No. of Applicants : 82

▶ Correct Answer : 6/82,  7.3%
  • - Red Cross Society Himeji Hospital , Japan Soichiro Okamoto
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Chungbuk national university , Korea (South) Yong Kim
▶ Correct Answer as Differential Diagnosis : 6/82,  7.3%
  • - GHICL , France manuel toledano
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Kyoto University , Japan Akihiko Sakata
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Centre Imagerie de Fribourg , Switzerland Benoit RIZK
▶ Semi-Correct Answer : 33/82,  40.2%
  • - Policlinico Umberto I , Italy Paolo Baldassari
  • - Jangsung public clinic , Korea (South) Yongsub Song
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Military service , Korea (South) Dongryul Jang
  • - Kyungpook national university hospital , Korea (South) Sung Jun Moon
  • - Chonnam National University Hospital , Korea (South) So Yeon Ki
  • - dayanand , India reena gupta
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - radiologist, aditya imaging centre , India vivek patel
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - McGill University Health Center , Canada Alexandre Semionov
  • - iran university , Iran Mohammad reza Ayoubpour
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Niigata University , Japan Atsushi Uehara
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Private sector , Greece Vasilios Tzilas
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - The University of Tokyo Hospital , Japan Kaoru Sumida
  • - NASA SCANS , India RAKESH BHATIA
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
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