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Alameer A, Duraikannu C, Kanodia AK, Dorward D. Pulmonary nodular lymphoid hyperplasia presenting as cavitating lung mass. BMJ Case Rep 2023; 16:e254121. [PMID: 37562862 PMCID: PMC10423788 DOI: 10.1136/bcr-2022-254121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare non-neoplastic disorder, which can mimic malignancy due to its indolent yet progressive nature. Here, we report a case of surgically proven PNLH that progressed over many years from a ground glass opacity to a solid cavitating lesion mimicking a slow growing primary lung carcinoma.
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Affiliation(s)
- Aqeel Alameer
- Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | - David Dorward
- Histopathology, Edinburgh Royal Infirmary, Edinburgh, UK
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Goh JTK, Al Jajeh I, Tan JHY. A Case of Pulmonary Nodular Lymphoid Hyperplasia Responding to Corticosteroid Treatment. Cureus 2023; 15:e37870. [PMID: 37091482 PMCID: PMC10117002 DOI: 10.7759/cureus.37870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 04/25/2023] Open
Abstract
Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare non-neoplastic disease that presents with mass lesions in the lung. It is radiologically difficult to differentiate it from adenocarcinoma of the lung or pulmonary lymphoma. There has been no consensus regarding the treatment of PNLH; however, in many case series, patients usually undergo surgical resection for diagnostic and therapeutic purposes. Here, we present the case of a 60-year-old Chinese male who presented with cough and hemoptysis. A computed tomography scan of the thorax revealed a mass-like lesion. A biopsy was performed which showed lymphocytic pneumonitis. He was treated with a tapering dose of corticosteroids with good clinical and radiological outcomes. Upon a subsequent review of the case, a diagnosis of PNLH was made. This case report suggests that corticosteroids may be an alternative therapy to surgical resection. They have the advantage of being non-invasive and can be used in patients who are otherwise not surgical candidates due to other comorbidities. However, further research is required before we can recommend corticosteroids as a treatment for PNLH.
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Moriyama S, Kido T, Sakamoto N, Fuchigami M, Tokito T, Okuno D, Miyamura T, Nakashima S, Hara A, Ishimoto H, Imaizumi Y, Tsuruda K, Yanagihara K, Fukuoka J, Mukae H. Pulmonary Nodular Lymphoid Hyperplasia Evaluated with Bronchoalveolar Lavage Fluid Findings: A Case Report and Review of the Literature on Japanese Patients. Intern Med 2023; 62:95-102. [PMID: 36596475 PMCID: PMC9876723 DOI: 10.2169/internalmedicine.9310-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pulmonary nodular lymphoid hyperplasia (PNLH) is a very rare disease, and it is difficult to diagnose PNLH and distinguish it from mucosa-associated lymphoid tissue (MALT) lymphoma. In addition, information on bronchoalveolar lavage fluid (BALF) analyses is lacking. We herein report a 36-year-old Japanese woman diagnosed with PLNH by a surgical biopsy and analysis of BALF. The BALF showed an increase in B-cell marker-positive lymphocytes, normal patterns of B-cell clonality, mucosa-associated lymphoid tissue 1 gene, and immunoglobulin heavy chain at 14q32 translocations. We also reviewed Japanese cases of PNLH described in Japanese or English to explore the characteristics of such cases.
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Affiliation(s)
- Sakiko Moriyama
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Mai Fuchigami
- Department of Laboratory Medicine, Nagasaki University Hospital, Japan
| | - Takatomo Tokito
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Daisuke Okuno
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takuto Miyamura
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shota Nakashima
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsuko Hara
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | - Kazuto Tsuruda
- Department of Laboratory Medicine, Nagasaki University Hospital, Japan
| | | | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Morizumi S, Morishita A, Nishiyama M, Takahashi K, Sumitomo K, Hino H, Naruse K, Takeuchi E, Sakiyama S, Shinohara T. Suspected Aspergillus nodule histologically consistent with pulmonary nodular lymphoid hyperplasia:a case report. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:499-502. [PMID: 37940538 DOI: 10.2152/jmi.70.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Aspergillus nodules (AN) are an unusual form of chronic pulmonary aspergillosis. On the other hand, pulmonary nodular lymphoid hyperplasia (PNLH) is classified as a reactive pulmonary lymphoproliferative disorder. A 65-year-old male was referred to our hospital due to a nodule in the left upper lobe. Histologically, a mixture of prominent lymphoid follicular formation, and hyaline necrosis were observed. Grocott staining revealed morphological forms of Aspergillus spp. in the necrosis. The final clinical diagnosis was suspected AN histologically consistent with PNLH. This case suggests that there may be PNLH cases in which local infection with Aspergillus contributes to its pathophysiology. J. Med. Invest. 70 : 499-502, August, 2023.
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Affiliation(s)
- Shun Morizumi
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Kochi, Japan
- Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Atsushi Morishita
- Division of Thoracic Surgery, National Hospital Organization Kochi Hospital, Kochi, Japan
- 4Division of Surgery, National Hospital Organization Higashi Tokushima Medical Center, Tokushima, Japan
| | - Miho Nishiyama
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Kochi, Japan
| | - Kiyohide Takahashi
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Kochi, Japan
| | - Kenya Sumitomo
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Kochi, Japan
| | - Hiroyuki Hino
- Division of Thoracic Surgery, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Keishi Naruse
- Division of Clinical Laboratory, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Eiji Takeuchi
- Department of Clinical Investigation, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Shoji Sakiyama
- Division of Thoracic Surgery, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Tsutomu Shinohara
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Kochi, Japan
- Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Nodular Lymphoid Hyperplasia as Incidental Finding of Suspect Pulmonary Mass. Case Rep Med 2022; 2022:2242418. [PMID: 35607351 PMCID: PMC9124141 DOI: 10.1155/2022/2242418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Nodular lymphoid hyperplasia of the lung is a rare disease of polyclonal lymphoid proliferation. The incidental finding of a solid nodular lesion with irregular margins adjacent to the visceral pleura in the reported case was highly suggestive of malignancy. The present report underscores the typical immunohistochemical findings and the benign course of nodular lymphoid hyperplasia. The current knowledge about disease aetiology and the value of different diagnostic tools to distinguish nodular lymphoid hyperplasia from other pulmonary lymphoid lesions are summarized by a review of the literature. Surgical resection is not only diagnostic but also curative with no evidence so far that NLH can regress without operation. The present case shows the spontaneous regression of NLH after CT-guided biopsy indicating that an alternative, less invasive diagnostic approach has curative potential.
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Cha YJ, Moon DH, Park JH, Lee S, Choi JA, Kim TH, Park CH. Pulmonary nodular lymphoid hyperplasia presenting as multifocal subsolid nodules: A case report and literature review. Respir Med Case Rep 2022; 36:101581. [PMID: 35036308 PMCID: PMC8749277 DOI: 10.1016/j.rmcr.2022.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 11/24/2022] Open
Abstract
Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare, benign lymphoproliferative disease, which is characterized by nonclonal lymphoproliferation. PNLH is usually asymptomatic and usually detected incidentally on imaging studies. Common imaging findings include a solitary nodule, multiple nodules, or focal consolidation. Atypically, PNLH may present with persistent subsolid nodules, mimicking adenocarcinoma. Here, we report a rare case of PNLH presenting as multifocal subsolid nodules in both lower lobes. During follow-up, persistency and growth of the subsolid nodules suggested the possibility of malignancy. Wedge resection was performed bilaterally, and PNLH was confirmed on pathological examination.
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Affiliation(s)
- Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Park
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Ae Choi
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul Hwan Park
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Savić Vuković A, Kukuljan M, Dinter M, Jurinović K, Jonjić N. The diagnostic challenge of adenocarcinoma in pulmonary nodular lymphoid hyperplasia. SAGE Open Med Case Rep 2021; 9:2050313X211039371. [PMID: 34721874 PMCID: PMC8552398 DOI: 10.1177/2050313x211039371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary nodular lymphoid hyperplasia is a rare, nonneoplastic lymphoproliferative disorder mostly manifesting as one or more nodules or localized lung infiltrates. The lesion comprises reactive germinal centers with well-preserved mantle zones and sheets of interfollicular mature plasma cells, lymphocytes, histiocytes, and neutrophils. The radiological finding is not specific, and the diagnosis of pulmonary nodular lymphoid hyperplasia relies generally on pathohistological and immunohistochemical analyses. The most important differential diagnoses are extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and immunoglobulin G4–related sclerosing disease. Nonetheless, we present a case of pulmonary nodular lymphoid hyperplasia in a 69-year-old woman with the diagnostic challenge of cytological atypia in alveolar spaces inside the lymphoid tissue, coexisting with the diagnosis of adenocarcinoma of the lepidic pattern. Therefore, this case highlights the importance of identifying these rare benign and reactive lymphoproliferative diseases given the risk of developing not only lymphoma but also carcinoma.
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Affiliation(s)
| | - Melita Kukuljan
- Clinical Hospital Center Rijeka, KBC Rijeka, Rijeka, Croatia
| | - Morana Dinter
- Department of Cytology, Clinical Hospital Center Rijeka, KBC Rijeka, Rijeka, Croatia
| | | | - Nives Jonjić
- Clinical Hospital Center Rijeka, KBC Rijeka, Rijeka, Croatia.,Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Yang Z, Wei L, Li X, Liu X. Pulmonary nodular lymphoid hyperplasia in a 53-year-old man with malignant sign: a case report. J Cardiothorac Surg 2021; 16:289. [PMID: 34627304 PMCID: PMC8502387 DOI: 10.1186/s13019-021-01672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare benign illness. Due to atypical clinical and radiographic presentations, diagnosis largely depends on postoperative pathological examination. Thus, preoperative misdiagnosis is often occurred. Case presentation We present a case of asymptomatic PNLH that was seen as ground-glass opacity (GGO) on computed tomography (CT). After 3-year observation, the diagnosis tends to adenocarcinoma owing to increasing density of the node and vessel convergence sign, which were signs of malignancy. Video-assisted segmentectomy (S10) was carried out. Histopathologic examination of postoperative specimen showed follicular lymphoid hyperplasia with interfollicular lymphoplasmacytosis, consistent with PNLH. The follow-up chest CT images showed no recurrence or metastasis. Conclusion Although it is a benign disease, PNLH can exhibit malignant signs in the imaging examinations, which could lead to misdiagnosis. This reminds us of the uncertainty between imaging findings and diagnosis. The diagnosis depends on postoperative pathological examination. Volume doubling time is a potential parameter to differentiate PNLH from lung cancer.
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Affiliation(s)
- Zhen Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Kunming Medical University, 374th Dianmian Road, Kunming, Yunnan Province, China
| | - Lianshuang Wei
- Department of Pathology, De Hong Zhou Ren Ming Yi Yuan, 13th Yonghan Street, Manshi, 678400, China
| | - Xu Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Kunming Medical University, 374th Dianmian Road, Kunming, Yunnan Province, China
| | - Xin Liu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Kunming Medical University, 374th Dianmian Road, Kunming, Yunnan Province, China.
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