대한흉부영상의학회 Weekly Chest Cases

Case No : 1136 Date 2019-08-04

Courtesy of Boda Nam, Jung Hwa Hwang / Soonchunhyang University Hospital
Age/Sex 58 / F
Chief Complaintcough (nonproductive, onset: two months ago)

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initial

Diagnosis With Brief Discussion

Diagnosis: Lymphocytic interstitial pneumonia and malignant lymphoma with Sjogren disease
Radiologic Findings: Initial chest radiography shows increased peripheral predominant opacities, poorly defined nodules and suspicious reticulation in both lungs. Mild right pleural thickening is also seen (figure 1).
On initial thin-section chest CT scans, relatively diffuse ground-glass opacities and poorly defined centrilobular micronodules are noted in both lungs (figure 2, 3). There is also reticulation with thickening of the intralobular lines and interlobular septae associated with mild traction bronchiolectasis in the subpleural areas of both basal lungs.
Four years later, follow-up chest radiography shows the progression of diffuse interstitial thickening with reticular opacities in both lungs. There are newly appeared airspace consolidations in the left lower lung, as well as mild mediastinal widening with increased opacity and left pleural effusion (figure 4). Chest CT lung window scan shows further progress and increased coarseness of reticulation in the subpleural areas of both basal lungs (figure 5, 6). There are newly appeared airspace consolidations as well as large nodules and diffuse thickening of the bronchovascular bundles and interlobular septae in the left lung. Conglomerated lymphadenopathy is newly noted at the left supraclavicular (figure 7), as well as the mediastinal and left axillary (figure 8) areas. A small amount of pleural effusion is also seen in the left lung.
An open lung biopsy was performed at the initial presentation and the case was histopathologically diagnosed as lymphocytic interstitial pneumonia (LIP).
Four years later, malignant lymphoma (T-cell/histiocyte rich large B-cell type) was diagnosed using a bone marrow biopsy and excision biopsy of the left axillary lymph nodes.
Brief Review: Lymphocytic interstitial pneumonia (LIP) is a benign lymphoproliferative disorder characterized by diffuse proliferation of polyclonal lymphocytes and plasma cells in the pulmonary parenchymal interstitium, with lymphoid follicles and germinal centers. It may be associated with a variety of autoimmune and lymphoproliferative disorders including Sj
Please refer to: Thoracic Imaging 2003- Korean & Japanese Film Interpretation - Case 8,
References: 1. Honda O, Johkoh T, Ichikado K et-al. Differential diagnosis of lymphocytic interstitial pneumonia and malignant lymphoma on high-resolution CT. AJR Am J Roentgenol. 1999;173 (1): 71-4
2. Johkoh T, M
Keywords: Lung, Interstitial pneumonia, Sjogren syndrome with Lymphoproliferative disease ,

No. of Applicants : 57

▶ Correct Answer : 12/57, 21.1%

- Affilitated Hospital of Jining Medical University , China HUA SHENG JIANG
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Ajou University Hospital , Korea (South) KYUNGMIN LEE
- Other , Korea (South) SEONGSU KANG
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Other , Korea (South) JUWON KIM
- Toranomon Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Ajou University Hospital , Korea (South) YONG HO JANG
- Ajou University Hospital , Korea (South) YOO YOUNGJIN

▶ Correct Answer as Differential Diagnosis : 19/57, 33.3%

- The University of Kyoto Hospital , Japan TOMOAKI OTANI
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- TWMU Medical Center East , Japan MASAFUMI KAIUME
- Mayo Clinic , United States AKITOSHI INOUE
- , Korea (South) CHOHEE KIM
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Gifu University Hospital , Japan Yo Kaneko
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- , Korea (South) JANG SEONG WON
- University of Tsukuba Hospital , Japan SODAI HOSHIAI
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- , Japan YUMI MAEHARA
- Hamamatsu University Hospital , Japan YUKI HAYASHI
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- Korea University Ansan Hospital , Korea (South) CHERRY KIM

▶ Semi-Correct Answer : 3/57, 5.3%

- Seoul National University Hospital , Korea (South) Ju Gang Nam
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Fujieda Municipal General Hospital , Japan HAYATO NOZAWA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Cases by Disease Category

Case No : 1136 Date 2019-08-04

Discussion

No. of Applicants : 57