대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary nodular lymphoid hyperplasia

Radiologic Findings

Fig 1. Serial lung window images of the initial chest CT scans show peribronchial airspace nodules in the right middle lobe and left upper lobe, as well as multifocal peribronchial patchy areas of ground glass opacities in both lungs.
Fig 2. Serial lung window images of follow-up chest CT scans obtained one year later show a migrating pattern of peribronchial airspace nodules and ground glass opacities in both lungs. Pathologic specimens obtained from the VATS wedge resection of right upper and lower lobes revealed nodular lymphoid hyperplasia.

Brief Review

Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare benign lymphoproliferative disorder of the lung, believed to result from reactive hyperplasia of bronchus-associated lymphoid tissue (1). Pathologically, PNLH is characterized by prominent germinal centers with interfollicular fibrosis and plasma cell infiltration (1). Imaging findings typically show well-defined single or multiple nodules, masses, or areas of consolidation ranging from 0.6 cm to 6 cm in size, as well as single or multiple ground-glass opacities or subsolid nodules (2, 3). Mediastinal and hilar lymphadenopathy as well as pleural effusion are typically absent. Most imaging abnormalities tend to persist, grow slowly, or both, often mimicking lung adenocarcinoma, metastasis, or lymphoma. Other differential diagnoses include follicular bronchiolitis, lymphoid interstitial pneumonia, and non-specific interstitial pneumonia. Despite being a benign lymphoproliferative disease, surgical resection remains the treatment of choice, with an excellent prognosis and no recurrence following surgery (4).

References

1. Abbondanzo SL, Rush W, Bijwaard KE, Koss MN. Nodular lymphoid hyperplasia of the lung: a clinicopathologic study of 14 cases. Am J Surg Pathol 2000; 24(4): 587-597
2. Hare SS, Souza CA, Bain G, et al. The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol 2012; 85(1015): 848-864
3. Cha YJ, Moon DH, Park JH, et al. Pulmonary nodular lymphoid hyperplasia presenting as multifocal subsolid nodules: A case report and literature review. Resp Med Case Rep 2022; 36:101581
4. Borie R, Wislez M, Antoine M, Cadranel J. Lymphoproliferative disorders of the lung. Respiration 2017; 94(2):157-175

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