Journal of Pathology and Translational Medicine

Original Article

Pulmonary Nodular Lymphoid Hyperplasia with Mass-Formation: Clinicopathologic Characteristics of Nine Cases and Review of the Literature: Jongmin Sim, Hyun Hee Koh, Sangjoon Choi, Jinah Chu, Tae Sung Kim, Hojoong Kim, Joungho Han; J Pathol Transl Med. 2018;52(4):211-218. Published online June 15, 2018; DOI: https://doi.org/10.4132/jptm.2018.04.27

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Background
Pulmonary nodular lymphoid hyperplasia (PNLH) is a non-neoplastic pulmonary lymphoid disorder that can be mistaken for malignancy on radiography. Herein, we present nine cases of PNLH, emphasizing clinicoradiological findings and histological features.
Methods
We analyzed radiological and clinicopathological features from the electronic medical records of nine patients (eight females and one male) diagnosed with PNLH. IgG and IgG4 immunohistochemical staining was performed in three patients.
Results
Two of the nine patients had experienced tuberculosis 40 and 30 years prior, respectively. Interestingly, none were current smokers, although two were ex-smokers. Three patients complaining of persistent cough underwent computed tomography of the chest. PNLH was incidentally discovered in five patients during examination for other reasons. The remaining patient was diagnosed with the disease following treatment for pneumonia. Imaging studies revealed consolidation or a mass-like lesion in eight patients. First impressions included invasive adenocarcinoma and mucosal-associated lymphoid tissue‒type lymphoma. Aspergillosis was suspected in the remaining patient based on radiological images. Resection was performed in all patients. Microscopically, the lesions consisted of nodular proliferation of reactive germinal centers accompanied by infiltration of neutrophils and macrophages in various degrees and surrounding fibrosis. Ultimately, all nine patients were diagnosed with PNLH and showed no evidence of recurrence on follow-up.
Conclusions
PNLH is an uncommon but distinct entity with a benign nature, and understanding the radiological and clinicopathological characteristics of PNLH is important.

Citations

Citations to this article as recorded by

Utilizing Immunoglobulin G4 Immunohistochemistry for Risk Stratification in Patients with Papillary Thyroid Carcinoma Associated with Hashimoto Thyroiditis
Faridul Haq, Gyeongsin Park, Sora Jeon, Mitsuyoshi Hirokawa, Chan Kwon Jung
Endocrinology and Metabolism.2024; 39(3): 468. CrossRef
Clinical and Imaging Features of Pulmonary Nodular Lymphoid Hyperplasia
Dong-Lei Nie, Yan-Hong Shi, Xin-Min Li, Xiao-Jiang Wang, Bao-Li Han, Guo-Fu Zhang
Journal of Thoracic Imaging.2024;[Epub] CrossRef
Pulmonary Nodular Lymphoid Hyperplasia Evaluated with Bronchoalveolar Lavage Fluid Findings: A Case Report and Review of the Literature on Japanese Patients
Sakiko Moriyama, Takashi Kido, Noriho Sakamoto, Mai Fuchigami, Takatomo Tokito, Daisuke Okuno, Takuto Miyamura, Shota Nakashima, Atsuko Hara, Hiroshi Ishimoto, Yoshitaka Imaizumi, Kazuto Tsuruda, Katsunori Yanagihara, Junya Fukuoka, Hiroshi Mukae
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A Case of Pulmonary Nodular Lymphoid Hyperplasia Responding to Corticosteroid Treatment
Jonathan Teow Koon Goh, Issam Al Jajeh, Jessica Han Ying Tan
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Pulmonary nodular lymphoid hyperplasia presenting as cavitating lung mass
Aqeel Alameer, Chary Duraikannu, Avinash Kumar Kanodia, David Dorward
BMJ Case Reports.2023; 16(8): e254121. CrossRef
Clinicopathological Characteristics and Curative Effect of Lymphoma Based on Sampling Theory
Shuxiang Ding, Leipo Liu
Mathematical Problems in Engineering.2022; 2022: 1. CrossRef
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Yoon Jin Cha, Duk Hwan Moon, Ji Hyun Park, Sungsoo Lee, Ji Ae Choi, Tae Hoon Kim, Chul Hwan Park
Respiratory Medicine Case Reports.2022; 36: 101581. CrossRef
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Journal of Cardiothoracic Surgery.2021;[Epub] CrossRef
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Case Reports

Cervical Lymphadenopathy Mimicking Angioimmunoblastic T-Cell Lymphoma after Dapsone-Induced Hypersensitivity Syndrome: Min Young Rim, Junshik Hong, Inku Yo, Hyeonsu Park, Dong Hae Chung, Jeong Yeal Ahn, Sanghui Park, Jinny Park, Yun Soo Kim, Jae Hoon Lee; Korean J Pathol. 2012;46(6):606-610. Published online December 26, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.6.606

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Abstract PDF

A 36-year-old woman presented with erythematous confluent macules on her whole body with fever and chills associated with jaundice after 8 months of dapsone therapy. Her symptoms had developed progressively, and a physical examination revealed bilateral cervical lymphadenopathy and splenomegaly. Excisional biopsy of a cervical lymph node showed effacement of the normal architecture with atypical lymphoid hyperplasia and proliferation of high endothelial venules compatible with angioimmunoblastic T-cell lymphoma. However, it was assumed that the cervical lymphadenopathy was a clinical manifestation of a systemic hypersensitivity reaction because her clinical course was reminiscent of dapsone-induced hypersensitivity syndrome. A liver biopsy revealed drug-induced hepatitis with no evidence of lymphomatous involvement. Intravenous glucocorticoid was immediately initiated and her symptoms and clinical disease dramatically improved. The authors present an unusual case of cervical lymphadenopathy mimicking angioimmunoblastic T-cell lymphoma as an adverse reaction to dapsone.

Citations

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Morphologic Spectrum of Lymphadenopathy in Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome
Hui-Chun Chen, Ren Ching Wang, Huey-Pin Tsai, L. Jeffrey Medeiros, Kung-Chao Chang
Archives of Pathology & Laboratory Medicine.2022; 146(9): 1084. CrossRef
Antibacterial antibiotic-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a literature review
Shiva Sharifzadeh, Amir Hooshang Mohammadpour, Ashraf Tavanaee, Sepideh Elyasi
European Journal of Clinical Pharmacology.2021; 77(3): 275. CrossRef
Drug-Induced Hypersensitivity Syndrome: A Clinical, Radiologic, and Histologic Mimic of Lymphoma
Faaria Gowani, Bradley Gehrs, Teresa Scordino
Case Reports in Hematology.2018; 2018: 1. CrossRef
In vitro testing for diagnosis of idiosyncratic adverse drug reactions: Implications for pathophysiology
Abdelbaset A. Elzagallaai, Michael J. Rieder
British Journal of Clinical Pharmacology.2015; 80(4): 889. CrossRef
Dapsone-induced drug reaction with eosinophilia and systemic symptoms syndrome, misdiagnosed as lymphoma
Bomi Shin, So Young Park, Sun-Young Yoon, Eun-Hye Shin, Young-Joo Yang, Hyung-Jin Cho, Il-Young Jang, Dong-Uk Kang, Tae-Bum Kim, You Sook Cho, Hee-Bom Moon, Hyouk-Soo Kwon
Allergy, Asthma & Respiratory Disease.2013; 1(4): 400. CrossRef
T-cell lymphoma presenting as drug rash with eosinophilia and systemic symptoms syndrome
Mi-Ae Kim, Hye-Soo Yoo, Sun Hyuk Hwang, Yoo Seob Shin, Dong-Ho Nahm, Hae-Sim Park
Allergy Asthma & Respiratory Disease.2013; 1(3): 280. CrossRef

A Case of Malignant Lymphoma Misdiagnosed as Focal Lymphoid Hyperplasia in the Esophagus.: Sook Keum Chung, Young Hyeh Ko, Chan Keum Park, Jung Dal Lee; Korean J Pathol. 1995;29(3):393-398.

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Abstract PDF: Esophageal involvement by malignant lymphoma is extremely rare. A case of follicular lymphoma of the esophagus, misdiagnosed as focal lymphoid hyperplasia (pseudolymphoma) in a 72-year-old man is presented. The esophagogram revealed diffuse narrowing of the lumen in the middle and distal portion without ulceration. The resected esophagus showed mural thickening without any remarkable mucosal change. Microscopically, the esophagus showed scattered follicular lymphoid aggregates in the submucosa, extending into periadventitial fat tissue. Most follicles were devoid of germinal center and consisted of loosely aggregated small cleaved cells without atypia. The surrounding stroma of the submucosa showed dense fibrosis entrapping the infiltrating small lymphocytes in a "indian-file" appearance. There were some reactive follicles with germinal center. In the lamina propria, many plasma cells and a few eosinophils were infiltrated. The gene rearrangement study showed rearranged band for Jk probe which confirmed monoclonal B-cell nature of infiltrated small lymphoid cells. The small cleaved lymphocytes arranged in follicles were positive for L26 and bcl-2 protein. This case demonstrated the necessity of immunophenotypic and gene rearrangement study in the diagnosis of pseudolymphoma in the digestive tract.

Orbital Pseudolymphoma: A case report.: Su Kyeong Yeon, Mi Kyung Jee, Seok Jin Kang, Byoung Kee Kim, Sun Moo Kim; Korean J Pathol. 1993;27(2):191-194.

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Abstract PDF: Lymphoid tumors of the orbit are rare, and sometimes it is not possible either clinically or histologically to differentiate between lymphoid tumor and pseudolymphoma. Some authors assert that the degree of cytologic differentiation appears to be the single most important factor for determining the prognosis of patients with orbital lymphoid lesions. However, the cytomorphologic basis is not so helpful to diagnose and classify our case, which shows some discrepancy between pathological findings and clinical and radiological findings. At first we misdiagnosed our case as orbital malignant lymphoma on the basis of cytomorphology and immunohistochemical study. But no responce to local intensive radiotherapy and the follow up study of the patient suggest orbital pseudolymphoma.

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