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Lucà S, Pagliuca F, Perrotta F, Ronchi A, Mariniello DF, Natale G, Bianco A, Fiorelli A, Accardo M, Franco R. Multidisciplinary Approach to the Diagnosis of Idiopathic Interstitial Pneumonias: Focus on the Pathologist's Key Role. Int J Mol Sci 2024; 25:3618. [PMID: 38612431 PMCID: PMC11011777 DOI: 10.3390/ijms25073618] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Idiopathic Interstitial Pneumonias (IIPs) are a heterogeneous group of the broader category of Interstitial Lung Diseases (ILDs), pathologically characterized by the distortion of lung parenchyma by interstitial inflammation and/or fibrosis. The American Thoracic Society (ATS)/European Respiratory Society (ERS) international multidisciplinary consensus classification of the IIPs was published in 2002 and then updated in 2013, with the authors emphasizing the need for a multidisciplinary approach to the diagnosis of IIPs. The histological evaluation of IIPs is challenging, and different types of IIPs are classically associated with specific histopathological patterns. However, morphological overlaps can be observed, and the same histopathological features can be seen in totally different clinical settings. Therefore, the pathologist's aim is to recognize the pathologic-morphologic pattern of disease in this clinical setting, and only after multi-disciplinary evaluation, if there is concordance between clinical and radiological findings, a definitive diagnosis of specific IIP can be established, allowing the optimal clinical-therapeutic management of the patient.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Fabio Perrotta
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Domenica Francesca Mariniello
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Giovanni Natale
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Andrea Bianco
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
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2
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Koslow M, Lynch DA, Cool CD, Groshong SD, Downey GP. Lymphangioleiomyomatosis and Other Cystic Lung Diseases. Immunol Allergy Clin North Am 2023; 43:359-377. [PMID: 37055093 PMCID: PMC10863428 DOI: 10.1016/j.iac.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Cysts and cavities in the lung are commonly encountered on chest imaging. It is necessary to distinguish thin-walled lung cysts (≤2 mm) from cavities and characterize their distribution as focal or multifocal versus diffuse. Focal cavitary lesions are often caused by inflammatory, infectious, or neoplastic processes in contrast to diffuse cystic lung diseases. An algorithmic approach to diffuse cystic lung disease can help narrow the differential diagnosis, and additional testing such as skin biopsy, serum biomarkers, and genetic testing can be confirmatory. An accurate diagnosis is essential for the management and disease surveillance of extrapulmonary complications.
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Affiliation(s)
- Matthew Koslow
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA; Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Carlyne D Cool
- Department of Pathology, University of Colorado School of Medicine Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; Division of Pathology, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Steve D Groshong
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA
| | - Gregory P Downey
- Department of Medicine, National Jewish Health, 1400 Jackson St, Denver, CO 80206, USA; Department of Pediatrics, National Jewish Health; Department of Immunology and Genomic Medicine, National Jewish Health
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Gozzi L, Cozzi D, Cavigli E, Moroni C, Giannessi C, Zantonelli G, Smorchkova O, Ruzga R, Danti G, Bertelli E, Luzzi V, Pasini V, Miele V. Primary Lymphoproliferative Lung Diseases: Imaging and Multidisciplinary Approach. Diagnostics (Basel) 2023; 13:diagnostics13071360. [PMID: 37046580 PMCID: PMC10093093 DOI: 10.3390/diagnostics13071360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Lymphoproliferative lung diseases are a heterogeneous group of disorders characterized by primary or secondary involvement of the lung. Primary pulmonary lymphomas are the most common type, representing 0.5–1% of all primary malignancies of the lung. The radiological presentation is often heterogeneous and non-specific: consolidations, masses, and nodules are the most common findings, followed by ground-glass opacities and interstitial involvement, more common in secondary lung lymphomas. These findings usually show a prevalent perilymphatic spread along bronchovascular bundles, without a prevalence in the upper or lower lung lobes. An ancillary sign, such as a “halo sign”, “reverse halo sign”, air bronchogram, or CT angiogram sign, may be present and can help rule out a differential diagnosis. Since a wide spectrum of pulmonary parenchymal diseases may mimic lymphoma, a correct clinical evaluation and a multidisciplinary approach are mandatory. In this sense, despite High-Resolution Computer Tomography (HRCT) representing the gold standard, a tissue sample is needed for a certain and definitive diagnosis. Cryobiopsy is a relatively new technique that permits the obtaining of a larger amount of tissue without significant artifacts, and is less invasive and more precise than surgical biopsy.
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Affiliation(s)
- Luca Gozzi
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Edoardo Cavigli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Moroni
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | | | - Giulia Zantonelli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Olga Smorchkova
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ron Ruzga
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ginevra Danti
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Bertelli
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Valentina Luzzi
- Interventional Pneumology, Careggi University Hospital, 50134 Florence, Italy
| | - Valeria Pasini
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, 50133 Florence, Italy
| | - Vittorio Miele
- Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
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4
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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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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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6
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Depascale R, Del Frate G, Gasparotto M, Manfrè V, Gatto M, Iaccarino L, Quartuccio L, De Vita S, Doria A. Diagnosis and management of lung involvement in systemic lupus erythematosus and Sjögren's syndrome: a literature review. Ther Adv Musculoskelet Dis 2021; 13:1759720X211040696. [PMID: 34616495 PMCID: PMC8488521 DOI: 10.1177/1759720x211040696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022] Open
Abstract
Lung involvement in systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS) has extensively been outlined with a multiplicity of different manifestations. In SLE, the most frequent finding is pleural effusion, while in pSS, airway disease and parenchymal disorders prevail. In both cases, there is an increased risk of pre-capillary and post-capillary pulmonary arterial hypertension (PAH) and pulmonary venous thromboembolism (VTE). The risk of VTE is in part due to an increased thrombophilic status secondary to systemic inflammation or to the well-established association with antiphospholipid antibody syndrome (APS). The lung can also be the site of an organ-specific complication due to the aberrant pathologic immune-hyperactivation as occurs in the development of lymphoma or amyloidosis in pSS. Respiratory infections are a major issue to be addressed when approaching the differential diagnosis, and their exclusion is required to safely start an immunosuppressive therapy. Treatment strategy is mainly based on glucocorticoids (GCs) and immunosuppressants, with a variable response according to the primary pathologic process. Anticoagulation is recommended in case of VTE and multi-targeted treatment regimens including different drugs are the mainstay for PAH management. Antibiotics and respiratory physiotherapy can be considered relevant complement therapeutic measures. In this article, we reviewed lung manifestations in SLE and pSS with the aim to provide a comprehensive overview of their diagnosis and management to physicians taking care of patients with connective tissue diseases.
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Affiliation(s)
- Roberto Depascale
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Giulia Del Frate
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Michela Gasparotto
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Valeria Manfrè
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Mariele Gatto
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Luca Quartuccio
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Unit, Department of Medicine, University of Udine, Udine, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy
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Bae CH, Lee SJ. Pediatric follicular bronchiolitis with severe atelectasis: a case report. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2021; 14:526-532. [PMID: 33936377 PMCID: PMC8085817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
Follicular bronchiolitis is a rare pulmonary disorder characterized by the presence of multiple hyperplastic lymphoid follicles with a peribronchiolar distribution. An 11-year-old girl with total atelectasis of the right middle lobe (RML) and diffuse multiple small nodules at both lung bases presented to our hospital with frequent upper respiratory infections and pneumonia. The disease progressed during a 3-month period of macrolide therapy, and thoracoscopic biopsy with lobectomy of the atelectatic RML was performed. The histopathologic diagnosis was follicular bronchiolitis. The patient's pulmonary function improved dramatically after oral steroid treatment. It can be difficult to diagnose follicular bronchiolitis based solely on clinical, laboratory, and radiologic findings; the disorder must be confirmed histopathologically. A patient with longstanding irreversible atelectasis and resulting recurrent respiratory infection may require lobectomy for the diagnosis and treatment of follicular bronchiolitis.
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Affiliation(s)
- Chi Hoon Bae
- Department of Thoracic & Cardiovascular Surgery, Daegu Catholic University Hospital, Catholic University of Daegu, College of Medicine South Korea
| | - Sun-Jae Lee
- Department of Pathology, Daegu Catholic University Hospital, Catholic University of Daegu, College of Medicine South Korea
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8
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Green DB, Restrepo CS, Legasto AC, Bang TJ, Oh AS, Vargas D. Imaging of the rare cystic lung diseases. Curr Probl Diagn Radiol 2021; 51:648-658. [PMID: 33618900 DOI: 10.1067/j.cpradiol.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
When discussing cystic lung diseases, a certain group of diseases tends to receive the majority of attention. Other less frequently discussed cystic lung diseases are also important causes of morbidity in patients. Etiologies include genetic syndromes, lymphoproliferative diseases, infections, exogenous exposures, and a developmental abnormality. This review article focuses on the clinical and imaging features of these other cystic lung diseases.
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Affiliation(s)
- Daniel B Green
- Department of Radiology, Weill Cornell Medicine, New York, NY.
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Tami J Bang
- Department of Radiology, University of Colorado, Aurora, CO
| | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO
| | - Daniel Vargas
- Department of Radiology, University of Colorado, Aurora, CO
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9
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Characteristics of primary Sjögren's syndrome related lymphocytic interstitial pneumonia. Clin Rheumatol 2020; 40:601-612. [PMID: 32613392 PMCID: PMC7327216 DOI: 10.1007/s10067-020-05236-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/29/2020] [Accepted: 06/10/2020] [Indexed: 12/03/2022]
Abstract
Objective This paper is aimed at investigating the clinical characteristics of primary Sjogren’s syndrome (pSS) with lymphocytic interstitial pneumonia (LIP). Methods The demographic data, clinical manifestations, laboratory and radiological findings, treatment, and prognosis from 15 cases of pSS-LIP patients were retrospectively analyzed. The data were compared with t test, χ2 test, and Pearson/Spearman correlation analysis. Results (1) Fifteen cases of patients with pSS-LIP are all females (100%). Compared with pSS with interstitial lung disease(pSS-ILD) patients, the incidence of dry cough, dental caries is higher in pSS-LIP patients. The incidence of shortness of breath, weight loss, and crackles is lower in pSS-LIP patients than that of pSS-ILD patients. (2) Compared with pSS-ILD patients, pSS-LIP patients had higher percentage of patients with ANA, anti-SSA52KD antibody, anti-SSA60KD antibody, and anti-SSB antibody, and the higher concentration of serum globulin. (3) Compared with pSS-ILD patients, the frequency of obstructive ventilation dysfunction is significantly higher and the frequency of diffusion dysfunction is significantly lower in pSS-LIP patients. (4) The most frequent HRCT findings in patients with pSS-LIP is cysts (100%), followed by ground-glass opacities (73.3%), nodular shadow (73.3%) among the pSS-LIP patients. Compared with PSS-ILD patients, the incidence of pulmonary nodule shadow is significantly higher in PSS-LIP patients, while that of grid shadow was significantly lower. (5) Compared with the baseline, the sum of the number, maximum diameter, and diameter of cysts in three levels of pSS-LIP patients showed an increasing trend after treatment. (6) Correlation analysis: The changes of ground-glass opacities were positively correlated with using GC or not, and those were negatively correlated with the dose of GC treatment. Besides, there is a positive correlation between the annual change rate of the maximum diameter of cysts (△Ømax1/t) and the use of CTX; there is a positive correlation between the annual change rate of the total diameter of cysts (△Øsum1/t) and the use of CTX. Conclusion To the patients of pSS-LIP, female were more common than male, and the onset of LIP was usually more insidious. Hyperglobulinemia and anti-SSA antibody were more prominent in patients with pSS-LIP. Pulmonary function showed the higher rate of obstructive ventilation dysfunction and the lower rate of diffusion dysfunction. The appearance of ground-glass opacities in pSS-LIP patients suggests that the infiltration of inflammatory cells increases, which may cause airway compression, the expansion of terminal bronchioles, and the formation of cysts. The more ground-glass opacities appear earlier, and the more appearance of new cysts later. Therapy with glucocorticoid may be effective on the ground-glass opacity during acute stage, and therapy with cyclophosphamide may be effective on the cysts during chronic stage. The heavier ground-glass opacity is at baseline, the more likely it will recur during maintenance treatment. So follow-up closely is needed.Key Points • It is the first clinical study with more cases of patients with pSS-LIP. • Female and hyperglobulinemia and anti-SSA antibody were more prominent in patients with pSS-LIP. • Pulmonary function showed the higher rate of obstructive ventilation dysfunction and the lower rate of diffusion dysfunction. • Therapy with glucocorticoid may be effective on the ground-glass opacity during acute stage, and therapy with cyclophosphamide may be effective on the cysts during chronic stage. |
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Nakano T, Kuwahira I, Shigemitsu H, Nakagawa T, Nagai A, Ebihara A, Oka T, Iwazaki M. A 48-Year-Old Man With Multiple Pulmonary Nodular Opacities and Elevated KL-6 Level. Chest 2018; 154:e77-e81. [PMID: 30195375 DOI: 10.1016/j.chest.2018.03.051] [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] [Received: 08/08/2017] [Revised: 02/22/2018] [Accepted: 03/08/2018] [Indexed: 10/28/2022] Open
Abstract
A 48-year-old man was referred for evaluation of an abnormal chest shadow noted on a routine chest radiograph during physical examination. He was asymptomatic and had no significant medical history and occupational exposure. The patient lived in Tokyo and had no significant travel history. He had smoked approximately 20 cigarettes daily for 20 years. He had no illicit drug use and no animal-rearing history.
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Affiliation(s)
- Takayuki Nakano
- Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Ichiro Kuwahira
- Department of Pulmonary Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Hidenobu Shigemitsu
- Department of Intensive Care Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tomoki Nakagawa
- Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Asuka Nagai
- Department of Pulmonary Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Akinori Ebihara
- Department of Pulmonary Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Teruaki Oka
- Department of Pathology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Masayuki Iwazaki
- Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
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11
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Sim J, Koh HH, Choi S, Chu J, Kim TS, Kim H, Han J. Pulmonary Nodular Lymphoid Hyperplasia with Mass-Formation: Clinicopathologic Characteristics of Nine Cases and Review of the Literature. J Pathol Transl Med 2018; 52:211-218. [PMID: 29902913 PMCID: PMC6056364 DOI: 10.4132/jptm.2018.04.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/27/2018] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Jongmin Sim
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hee Koh
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangjoon Choi
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinah Chu
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Kim
- Department of Radiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Abstract
Primary pulmonary lymphomas represent a pathologically heterogeneous group of disorders that often share imaging features, which include peribronchovascular nodules and masses or areas of nonresolving consolidation. Primary mediastinal B-cell lymphoma is an extranodal non-Hodgkin lymphoma seen in younger patients that has imaging and pathologic features that demonstrate some degree of overlap with Hodgkin lymphoma. Primary lymphomas of the pleural space are rare and associated with concomitant viral infections.
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13
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Sirajuddin A, Raparia K, Lewis VA, Franks TJ, Dhand S, Galvin JR, White CS. Primary Pulmonary Lymphoid Lesions: Radiologic and Pathologic Findings. Radiographics 2016; 36:53-70. [PMID: 26761531 DOI: 10.1148/rg.2016140339] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The pulmonary lymphoid system is complex and is composed of two compartments: the pulmonary lymphatics and the bronchus-associated lymphoid tissue (BALT). Additional important cells that function in the pulmonary lymphoid system include dendritic cells, Langherhans cells, macrophages, and plasma cells. An appreciation of the normal lymphoid anatomy of the lung as well as its immunology is helpful in understanding the radiologic and pathologic findings of the primary pulmonary lymphoid lesions. Primary lymphoid lesions of the lung arise from the BALT and are uncommon. However, they are increasingly recognized within the growing number of posttransplant patients as well as other patients who are receiving immunosuppressive therapies. Primary lymphoid lesions encompass a wide range of benign and malignant lesions. Benign lymphoid lesions of the lung include reactive lymphoid hyperplasia, follicular bronchiolitis, lymphoid interstitial pneumonia, and nodular lymphoid hyperplasia. Malignant lymphoid lesions of the lung include low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), other non-Hodgkin lymphomas, and Hodgkin lymphoma. Last, a miscellaneous group of primary lymphoid lesions includes lymphomatoid granulomatosis, posttransplant lymphoproliferative disorders, acquired immunodeficiency syndrome (AIDS)-related lymphoma, and intravascular lymphoma/lymphomatosis. These lesions are best evaluated with multidetector chest computed tomography. The radiologic findings of the primary lymphoid lesions are often nonspecific and are best interpreted in correlation with clinical data and pathologic findings. The purpose of this article is to review pulmonary lymphoid anatomy as well as the most common primary pulmonary lymphoid disorders.
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Affiliation(s)
- Arlene Sirajuddin
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Kirtee Raparia
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Vanessa A Lewis
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Teri J Franks
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Sabeen Dhand
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Jeffrey R Galvin
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Charles S White
- From the Department of Medical Imaging, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (A.S.); Departments of Pathology (K.R.) and Radiology (V.A.L., S.D.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pulmonary and Mediastinal Pathology, The Joint Pathology Center, Silver Spring, Md (T.J.F.); Departments of Diagnostic Radiology (Chest Imaging) and Internal Medicine (Pulmonary/Critical Care), University of Maryland School of Medicine, Baltimore, Md (J.R.G., C.S.W.); and American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
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14
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Abstract
Lymphocytic interstitial pneumonia (LIP) is a rare lung disease on the spectrum of benign pulmonary lymphoproliferative disorders. LIP is frequently associated with connective tissue diseases or infections. Idiopathic LIP is rare; every attempt must be made to diagnose underlying conditions when LIP is diagnosed. Computed tomography of the chest in patients with LIP may reveal ground-glass opacities, centrilobular and subpleural nodules, and randomly distributed thin-walled cysts. Demonstrating polyclonality with immunohistochemistry is the key to differentiating LIP from lymphoma. The 5-year mortality remains between 33% and 50% and is likely to vary based on the underlying disease process.
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Affiliation(s)
- Tanmay S Panchabhai
- Department of Medicine, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, Phoenix Regional Campus, 500 West Thomas Road, Suite 500, Phoenix, AZ 85013, USA
| | - Carol Farver
- Department of Anatomic Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Pathology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH 44195, USA
| | - Kristin B Highland
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, A90, Cleveland, OH 44195, USA.
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15
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Raoof S, Bondalapati P, Vydyula R, Ryu JH, Gupta N, Raoof S, Galvin J, Rosen MJ, Lynch D, Travis W, Mehta S, Lazzaro R, Naidich D. Cystic Lung Diseases: Algorithmic Approach. Chest 2016; 150:945-965. [PMID: 27180915 DOI: 10.1016/j.chest.2016.04.026] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 02/16/2016] [Accepted: 04/06/2016] [Indexed: 12/14/2022] Open
Abstract
Cysts are commonly seen on CT scans of the lungs, and diagnosis can be challenging. Clinical and radiographic features combined with a multidisciplinary approach may help differentiate among various disease entities, allowing correct diagnosis. It is important to distinguish cysts from cavities because they each have distinct etiologies and associated clinical disorders. Conditions such as emphysema, and cystic bronchiectasis may also mimic cystic disease. A simplified classification of cysts is proposed. Cysts can occur in greater profusion in the subpleural areas, when they typically represent paraseptal emphysema, bullae, or honeycombing. Cysts that are present in the lung parenchyma but away from subpleural areas may be present without any other abnormalities on high-resolution CT scans. These are further categorized into solitary or multifocal/diffuse cysts. Solitary cysts may be incidentally discovered and may be an age related phenomenon or may be a remnant of prior trauma or infection. Multifocal/diffuse cysts can occur with lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, tracheobronchial papillomatosis, or primary and metastatic cancers. Multifocal/diffuse cysts may be associated with nodules (lymphoid interstitial pneumonia, light-chain deposition disease, amyloidosis, and Langerhans cell histiocytosis) or with ground-glass opacities (Pneumocystis jirovecii pneumonia and desquamative interstitial pneumonia). Using the results of the high-resolution CT scans as a starting point, and incorporating the patient's clinical history, physical examination, and laboratory findings, is likely to narrow the differential diagnosis of cystic lesions considerably.
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Affiliation(s)
| | | | | | | | - Nishant Gupta
- Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati
| | | | - Jeff Galvin
- Department of Radiology, University of Maryland
| | - Mark J Rosen
- Pulmonary, Critical Care and Sleep Medicine, North Shore University Hospital
| | - David Lynch
- Department of Radiology, National Jewish Health
| | - William Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | - Richard Lazzaro
- Department of Thoracic Surgery, Lenox Hill Hospital, Northwell Health
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16
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Pulmonary Nodular Lymphoid Hyperplasia presenting cavitating pulmonary nodules. Pathol Res Pract 2015; 211:1006-9. [PMID: 26514894 DOI: 10.1016/j.prp.2015.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/21/2015] [Accepted: 09/01/2015] [Indexed: 11/21/2022]
Abstract
Pulmonary Nodular Lymphoid Hyperplasia (PNLH) is a rare benign pulmonary disorder characterized by a localized, reactive polyclonal lymphoproliferation. Although the radiological features of this disease have not been clearly defined, they usually consist of a solitary non-cavitatory pulmonary nodule. In this report, we describe two cases of histologically confirmed PNLH presenting as multiple bilateral cavitatory lesions on CT Thorax.
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17
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Kanık ET, Yılmaz Ö, Türkeli A, Şahin Ş, Yüksel H. Follicular bronchiolitis: a rare disease in children. TURK PEDIATRI ARSIVI 2015; 49:344-7. [PMID: 26078687 DOI: 10.5152/tpa.2014.306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 01/16/2013] [Indexed: 11/22/2022]
Abstract
Follicular bronchiolitis (FB) is a benign progressive lung disease. It is characterized with lymphoplasmocellular infiltration and hyperplastic follicles in the peribronchial areas in the small airways. Follicular bronchiolitis should be considered in cases where chronic cough, recurrent upper respiratory tract infections and progressive dyspnea are observed in children. The diagnosis should be supported by lung biopsy. A 8-year old female patient presented to our hospital with complaints including continuing cough and wheezing. Bilateral extensive rales and rhonchi in the lungs were heard on auscultation and lung graphy revealed reticuloglandular appearance. Bilateral extensive septal thickennings, reticulonodular appearance, patchy bronchiectasis, bronchiolectasis and peribronchial thickennings were found on high-resolution thoracal computarized tomography. A diagnosis of follicular bronchiolitis was made as a result of lung biopsy. Improvement was observed in the complaints and findings of our patient after methylprednisolone treatment. This patient was presented to emphasize rare interstitial lung diseases should also be considered in children who present with a clinical picture of chronic bronchial obstruction and do not respond to standard treatment.
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Affiliation(s)
- Esra Toprak Kanık
- Division of Pediatric Allergy and Pulmonology Unit, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Özge Yılmaz
- Division of Pediatric Allergy and Pulmonology Unit, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ahmet Türkeli
- Division of Pediatric Allergy and Pulmonology Unit, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Şebnem Şahin
- Department of Pediatrics, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Hasan Yüksel
- Division of Pediatric Allergy and Pulmonology Unit, Celal Bayar University Faculty of Medicine, Manisa, Turkey
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18
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Thalanayar PM, Holguin F. Follicular bronchiolitis in primary ciliary dyskinesia. Australas Med J 2014; 7:294-7. [PMID: 25157269 DOI: 10.4066/amj.2014.2102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ciliary dysfunction in primary ciliary dyskinesia (PCD) may be associated with bronchiolitis. Diffuse bronchiolitis has been reported in a subset of PCD patients who have Kartagener's syndrome in Japan. We report a case of follicular bronchiolitis (FB) in a case of PCD presenting with recurrent episodes of cough, dyspnea, and bronchiectasis. This may motivate researchers to study rarer variants and presentations in PCD.
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Affiliation(s)
- Prashanth M Thalanayar
- Dept. of Internal medicine, University of Pittsburgh Medical Center, McKeesport, PA, USA
| | - Fernando Holguin
- Asthma Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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19
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Carrillo J, Restrepo CS, Rosado de Christenson M, Ojeda Leon P, Lucia Rivera A, Koss MN. Lymphoproliferative lung disorders: a radiologic-pathologic overview. Part I: Reactive disorders. Semin Ultrasound CT MR 2014; 34:525-34. [PMID: 24332204 DOI: 10.1053/j.sult.2013.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lymphoid tissue is a normal component of the lung and manifests as intrapulmonary lymph nodes, bronchus-associated lymphoid tissue (BALT), peripheral lymphocytic aggregates, solitary lymphocytes, and phagocytic cells. Pulmonary lymphoid lesions are thought to develop as a consequence of anomalous stimulation and response of the bronchus-associated lymphoid tissue and manifests as a spectrum of lymphoproliferative disorders that may be reactive or neoplastic. Reactive disorders are polyclonal abnormalities and include nodular lymphoid hyperplasia, lymphocytic interstitial pneumonia, follicular bronchiolitis, angiofollicular hyperplasia, and enlarged intrapulmonary lymph nodes. Affected patients are often asymptomatic. Imaging findings include focal nodules, diffuse bilateral centrilobular nodules, and hilar or mediastinal masses.
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Affiliation(s)
- Jorge Carrillo
- Department of Radiology, Universidad Nacional de Colombia, Bogota, DC
| | - Carlos S Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | | | | | - Aura Lucia Rivera
- Department of Radiology, Hospital Universiatario Mayor Mederi, Bogota, DC
| | - Micheal N Koss
- Department of Pathology, University of Southern California, Los Angeles, CA
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20
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Yoshida K, Kobayashi S, Matsui O, Gabata T, Sanada J, Koda W, Minami T, Ryu Y, Kozaka K, Kitao A. Hepatic pseudolymphoma: imaging-pathologic correlation with special reference to hemodynamic analysis. ACTA ACUST UNITED AC 2014; 38:1277-85. [PMID: 23744440 DOI: 10.1007/s00261-013-0016-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To clarify radiological findings and hemodynamic characteristics of hepatic pseudolymphoma, as compared with the histopathological findings. METHODS Radiological findings of ten histopathologically confirmed hepatic pseudolymphomas in seven patients were examined using US, CT, and MRI. Six patients also underwent angiography-assisted CT, including CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) to analyze hemodynamics. RESULTS The nodules were depicted as hypoechoic on US, hypodense on precontrast CT, hypointense on T1-weighted images, and hyperintense on T2-weighted images. On contrast-enhanced CT/MRI, they showed various degrees of enhancement, and sometimes, perinodular enhancement was observed at the arterial dominant and/or equilibrium phase. On CTAP, the nodules showed portal perfusion defects, including some in the perinodular liver parenchyma. On CTHA, irregular bordered enhancement was observed in perinodular liver parenchyma on early phase, and continued until delayed phase. Some nodules had preserved intra-tumoral portal tracts. Histopathologically, the nodules consisted of marked lymphoid cells. In perinodular liver parenchyma, stenosis or disappearance of portal venules, caused by lymphoid cell infiltration in the portal tracts, was observed. CONCLUSIONS Hepatic pseudolymphoma showed some characteristic radiological findings including hemodynamics on CT, MRI, and angiography-assisted CT. These findings are useful in the differentiation from hepatocellular carcinoma and other tumors.
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Affiliation(s)
- Kotaro Yoshida
- Department of Radiology, Kanazawa University School of Medicine, 13-1, Takara-Machi, Kanazawa, 920-8641, Japan,
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21
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Santiago T, Santiago M, Rovisco J, Ferreira J, Duarte C, Malcata A, Da Silva JAP. Coexisting primary Sjögren’s syndrome and sarcoidosis: coincidence, mutually exclusive conditions or syndrome? Rheumatol Int 2014; 34:1619-22. [DOI: 10.1007/s00296-014-3024-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
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22
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Shipe R, Lawrence J, Green J, Enfield K. HIV-associated follicular bronchiolitis. Am J Respir Crit Care Med 2014; 188:510-1. [PMID: 23947519 DOI: 10.1164/rccm.201206-1096im] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ryan Shipe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Massachusetts, Worcester, MA, USA
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23
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Stolagiewicz N, Tinwel B, Cormack IS, Lucas SB, Devaraj A, Kay-Loke T, Chua F. Spontaneous pneumothorax in a 50-year-old man with diffuse pulmonary nodules. Chest 2013; 143:1174-1179. [PMID: 23546494 DOI: 10.1378/chest.12-0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Brendan Tinwel
- Pathology Department, Croydon University Hospital, Croydon
| | - Ian S Cormack
- Department of Genito-Urinary Medicine, Croydon University Hospital, Croydon
| | - Sebastian B Lucas
- Histopathology Department, School of Medicine, King's College London, London, England
| | - Anand Devaraj
- Radiology Department, St. George's Hospital NHS Trust, London
| | - Tuck Kay-Loke
- Department of Respiratory Medicine, Croydon University Hospital, Croydon
| | - Felix Chua
- Respiratory Medicine Department, Croydon University Hospital, Croydon
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24
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Dias Â, Jardim J, Nunes T, Souto Moura C, Vaz L. Follicular bronchiolitis: A rare cause of persistent atelectasis in children. Respir Med Case Rep 2013; 10:7-9. [PMID: 26029501 PMCID: PMC3920439 DOI: 10.1016/j.rmcr.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/10/2013] [Accepted: 06/17/2013] [Indexed: 11/11/2022] Open
Abstract
Although atelectasis is common in children, its persistence or refractoriness to treatment should lead prompt evaluation to identify causal mechanism. We describe the case of a child presenting in first year of life with persistent left upper lobe atelectasis, recurrent wheezing and respiratory infections refractory to medical therapy, submitted to partial lobectomy when he was 3 years old age. Histopathological examination revealed follicular bronchiolitis. Systemic underlying diseases were excluded. Clinical improvement was initially achieved using inhaled corticosteroids, but oral therapy was needed due to clinical relapse, with favorable response. Follicular bronchiolitis, a rare pulmonary primary lymphoid lesion, consists of numerous reactive lymphoid follicles in a peribonchiolar distribution. Its precise cause is unknown, particularly in children, in which few cases have been reported. Treatment usually includes steroids and prognosis is generally good.
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Affiliation(s)
- Ângela Dias
- Unidade de Pneumologia Pediátrica, Serviço de Pediatria, Centro Hospitalar São João, Porto, Portugal
| | - Joana Jardim
- Unidade de Pneumologia Pediátrica, Serviço de Pediatria, Centro Hospitalar São João, Porto, Portugal
| | - Teresa Nunes
- Unidade de Pneumologia Pediátrica, Serviço de Pediatria, Centro Hospitalar São João, Porto, Portugal
| | - Conceição Souto Moura
- Serviço de Anatomia Patológica, Centro Hospitalar São João, Porto, Portugal ; Faculdade de Medicina do Porto, Portugal
| | - Luísa Vaz
- Unidade de Pneumologia Pediátrica, Serviço de Pediatria, Centro Hospitalar São João, Porto, Portugal
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25
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26
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A Case of Follicular Bronchiolitis as the Histological Counterpart to Nodular Opacities in Bronchiectatic Mycobacterium avium Complex Disease. Case Rep Pulmonol 2012; 2012:214601. [PMID: 23133778 PMCID: PMC3485900 DOI: 10.1155/2012/214601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 09/30/2012] [Indexed: 11/17/2022] Open
Abstract
Here we report the case of a 72-year-old woman with nodular bronchiectatic Mycobacterium avium complex (MAC) disease. Chest computed tomography on admission revealed multiple micronodular and branching opacities in both lobes with segmental distribution; bronchiectasis and bronchial wall thickening were observed in the middle lobe and lingula. The patient consented to and underwent thoracoscopic lung biopsy; epithelioid granulomas were occasionally observed, but follicular bronchiolitis was widespread. While bronchial lesions from nontuberculous mycobacterial infection generally present as epitheliod granulomas, the present case suggests that follicular bronchiolitis can also be a histological counterpart to nodular opacities in nodular bronchiectatic MAC disease.
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27
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Terada T. CD5-positive marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) of the lung. Diagn Pathol 2012; 7:16. [PMID: 22333190 PMCID: PMC3298797 DOI: 10.1186/1746-1596-7-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/14/2012] [Indexed: 11/22/2022] Open
Abstract
CD5-positive marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) of the lung is very rare. An 82-year-old Japanese woman was found to have an abnormal lung shadow on chest X-ray photography, and was admitted to our hospital. Imaging modalities including X-ray photography, computed tomography, and magnetic resonance imaging showed a small (2 × 1 × 1 cm) opacity of the right upper lobe. Transbronchial lung biopsy was performed. It showed severe proliferation of small lymphocytes. The small lymphocytes were centrocytes-like, and minor plasma cell differentiation was recognized. Lymphoepithelial lesions were scattered. Immunohistochemically, the tumor cells were positive for CD5, CD20, CD43, CD45, CD79α, bcl-2, and κ-chain, but negative for CD2, CD3, CD10, CD21, CD23, CD35, CD45RO, CD56, IgA, IgG, IgM, IgD, λ-chain, TdT, and cyclin D1. The Ki-67 labeling was 10%. CD3-positive and CD45RO-positive inflammatory T-cells were scattered in small amount. The pathological diagnosis was CD5-positive marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) of the lung. The patient was treated with chemotherapy (CHOP: cyclophosphamide, hydroxydaunorbicin, vincristine, and predonisone), and the lung tumor disappeared. The patient is now free of the lymphoma 10 years after the first manifestation.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan.
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28
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Hampson FA, Chandra A, Screaton NJ, Condliffe A, Kumararatne DS, Exley AR, Babar JL. Respiratory disease in common variable immunodeficiency and other primary immunodeficiency disorders. Clin Radiol 2012; 67:587-95. [PMID: 22226567 DOI: 10.1016/j.crad.2011.10.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/06/2011] [Accepted: 10/12/2011] [Indexed: 12/27/2022]
Abstract
Respiratory disease is a significant cause of morbidity and mortality amongst patients with primary immunodeficiency disorders. Computed tomography (CT) plays an important role in the multidisciplinary approach to these conditions, in detecting, characterizing, and quantifying the extent of lung damage and in directing treatment. The aim of this review is to classify the primary immunodeficiency disorders and describe the thoracic complications and the associated CT findings whilst discussing the role of radiology in diagnosis and surveillance.
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Affiliation(s)
- F A Hampson
- Department of Radiology, Papworth Hospital, Papworth Everard, Cambridge, UK
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29
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Terada T. Follicular bronchiolitis and lymphocytic interstitial pneumonia in a Japanese man. Diagn Pathol 2011; 6:85. [PMID: 21936908 PMCID: PMC3192727 DOI: 10.1186/1746-1596-6-85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 09/21/2011] [Indexed: 11/10/2022] Open
Abstract
A 44-year-old Japanese man consulted to our hospital because of cough and sputum. Chest-XP and CT revealed diffuse reticular opacities in both lungs.A transbronchial lung biopsy (TBLB) showed a moderate infiltration of lymphocytes in the alveolar septae. He was diagnosed as interstitial pneumonia, and treated by drugs. One year later, his condition deteriolated, and a large open biopsy was performed. It showed a diffuse severe infiltration of lymphocytes in the alveolar walls and a few epithelioid granulomas. No bronchiolitis was seen.Immunohistochemical study denied lymphocyte monoclonality, and he was diagnosed as lymphocytic interstitial pneumonia (LIP). He was treated by steroid.Six months later, TBLB showed peribronchial lymphocyte infiltration. A large open biopsy also revealed a severe lymphocytic infiltration around the bronchioles, sparing alveolar wall lymphocytic infiltration. Immunohistochemical study denied malignant lymphoma. He was diagnosed as follicular bronchiolitis (FB). One year later, TBLB showed little lymphocytic infiltration in the alveolar walls as well as peribronchial walls. Two years later, his condition became worse, and TBLB showed features of LIP. Later, his condition was stationary for 6 years with mild lung opacities for 6 years. These findings show that LIP and FB are interchangeable and overlapping, and suggest that LIP and FB belong to the same spectrum of benign lymphoproliferative disorders of the lungs.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan.
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30
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da Silva SP, Resnick E, Lucas M, Lortan J, Patel S, Cunningham-Rundles C, Gatter K, Liu Q, Jaffe ES, Chapel H. Lymphoid proliferations of indeterminate malignant potential arising in adults with common variable immunodeficiency disorders: unusual case studies and immunohistological review in the light of possible causative events. J Clin Immunol 2011; 31:784-91. [PMID: 21744182 DOI: 10.1007/s10875-011-9565-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 06/28/2011] [Indexed: 12/14/2022]
Abstract
Patients with common variable immunodeficiency disorders (CVIDs) who developed B cell lymphoproliferation of indeterminate malignant potential are described in order to raise a discussion of the relationship between infection and lymphoproliferation in infection prone patients. Those with CVID are at risk of developing either polyclonal or monoclonal lymphoproliferation in part due to the dysregulation of their adaptive immune systems. The aetiologies of the lymphoproliferations are unknown but intriguing; the relevance of infection being particularly problematic. The patients described here demonstrate variability in preceding infection, age at presentation, response to antibiotics and other types of therapy as well as outcome. The question of treatment is also controversial; issues include whether antibiotics or chemotherapy are the first line of therapy in all patients and whether transformation to aggressive B cell malignancy is inevitable or depends on other factors and if so, the length of time for such progression.
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MESH Headings
- Adult
- Aged
- Aspergillosis/diagnosis
- Aspergillosis/etiology
- Aspergillosis/immunology
- Aspergillosis/pathology
- Aspergillosis/physiopathology
- Aspergillus fumigatus/immunology
- Aspergillus fumigatus/pathogenicity
- Autoimmunity
- B-Lymphocytes/immunology
- B-Lymphocytes/microbiology
- B-Lymphocytes/pathology
- B-Lymphocytes/virology
- Cell Transformation, Neoplastic
- Cell Transformation, Viral
- Common Variable Immunodeficiency/complications
- Common Variable Immunodeficiency/diagnosis
- Common Variable Immunodeficiency/immunology
- Common Variable Immunodeficiency/pathology
- Common Variable Immunodeficiency/physiopathology
- Diagnosis, Differential
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/etiology
- Epstein-Barr Virus Infections/immunology
- Epstein-Barr Virus Infections/pathology
- Epstein-Barr Virus Infections/physiopathology
- Fatal Outcome
- Female
- Herpesvirus 4, Human/immunology
- Herpesvirus 4, Human/pathogenicity
- Humans
- Lung/immunology
- Lung/microbiology
- Lung/pathology
- Lung/virology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/immunology
- Lung Neoplasms/pathology
- Lung Neoplasms/physiopathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/physiopathology
- Lymphoproliferative Disorders
- Male
- Middle Aged
- Precancerous Conditions/pathology
- Remission, Spontaneous
- Skin/immunology
- Skin/microbiology
- Skin/pathology
- Skin/virology
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31
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Guinee DG. Update on nonneoplastic pulmonary lymphoproliferative disorders and related entities. Arch Pathol Lab Med 2010; 134:691-701. [PMID: 20441500 DOI: 10.5858/134.5.691] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Recent discoveries have expanded the spectrum of nonneoplastic pulmonary lymphoproliferative disorders and have provided new insights into their pathogenesis and treatment. OBJECTIVE To review the thoracic manifestations of immunoglobulin (Ig) G4-related sclerosing disease and summarize current concepts and differential diagnosis of follicular bronchiolitis, lymphocytic interstitial pneumonitis, and nodular lymphoid hyperplasia. DATA SOURCES Data sources include recent and old articles, cases from the personal files of the author, and cases borrowed with permission from other authors. CONCLUSIONS Additional studies will be needed to further refine and add to observations in this evolving area of pulmonary pathology.
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Affiliation(s)
- Donald G Guinee
- Department of Pathology, Virginia Mason Medical Center, Seattle, Washington 98101, USA.
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32
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Miyoshi S, Hamada H, Katayama H, Hamaguchi N, Irifune K, Ito R, Ohtsuki Y, Yoshino T, Higaki J. A case of pulmonary nodular lymphoid hyperplasia with a resected cavity, followed by spontaneous regression of the remaining lesions. Intern Med 2010; 49:1617-21. [PMID: 20686301 DOI: 10.2169/internalmedicine.49.3487] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 50-year-old man was admitted to our hospital for examination of an abnormal shadow on chest radiography. Computed tomography revealed multiple small nodular shadows in bilateral lung fields, with cavitation in a right S3 lesion that was resected by video-assisted thoracoscopic surgery. Histopathological examination revealed marked proliferation of lymphoid tissue, including many plasma cells that were polyclonal in nature. This case was considered to be pulmonary nodular lymphoid hyperplasia (PNLH). Several residual nodules spontaneously disappeared during the 6 years of follow-up. This was a rare case of PNLH with a resected cavity, followed by spontaneous regression of the remaining lesions.
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Affiliation(s)
- Seigo Miyoshi
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Toon
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33
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Hoey E, Mankad K. Answer to Case of the Month #158. Can Assoc Radiol J 2009; 60:283-4. [DOI: 10.1016/j.carj.2009.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Edward Hoey
- Radiology Academy, Leeds General Infirmary, Leeds, UK
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34
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35
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Brillet P, Mama N, Nunes H, Uzunhan Y, Abbad S, Brauner M. Sémiologie tomodensitométrique de l’atteinte pulmonaire des connectivites. ACTA ACUST UNITED AC 2009; 90:1854-68. [DOI: 10.1016/s0221-0363(09)73288-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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36
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F-18 FDG PET/CT Findings in A Case of Multifocal Nodular Lymphoid Hyperplasia of the Lung. Clin Nucl Med 2009; 34:374-6. [DOI: 10.1097/rlu.0b013e3181a34591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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38
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Chhieng DC. Cytology of bronchial associated lymphoid tissue lymphoma. Diagn Cytopathol 2008; 36:723-8. [DOI: 10.1002/dc.20877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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39
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Balestro E, Polverosi R, Vassallo R, Pastore U, Dal Farra F, Rossi G, Calabro S. A 40-year-old man with hemolytic anemia, Ig deficiency, and bilateral pulmonary infiltrates. Chest 2008; 133:1517-1523. [PMID: 18574299 DOI: 10.1378/chest.07-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Elisabetta Balestro
- Respiratory Disease Department, Hospital S. Bassiano, Bassano del Grappa, Italy.
| | - Roberta Polverosi
- Radiology Department, Hospital S. Bassiano, Bassano del Grappa, Italy
| | - Robert Vassallo
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Umberto Pastore
- Respiratory Disease Department, Hospital S. Bassiano, Bassano del Grappa, Italy
| | - Fabrizio Dal Farra
- Respiratory Disease Department, Hospital S. Bassiano, Bassano del Grappa, Italy
| | - Giancarlo Rossi
- Respiratory Disease Department, Hospital S. Bassiano, Bassano del Grappa, Italy
| | - Stefano Calabro
- Respiratory Disease Department, Hospital S. Bassiano, Bassano del Grappa, Italy
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40
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[Incindentally detected Castleman disease in a patient with allergic rhinosinusitis]. SRP ARK CELOK LEK 2008; 136:46-9. [PMID: 18410038 DOI: 10.2298/sarh0802046s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Castleman disease was for the first time described in 1956 as a mediastinal tumour mass. Etiology of this disease is still unknown. The disease can be solitary and multicentric or rarely of a mixed type. The former is often of hyaline vascular type, while the latter is of plasma cell type. CASE REPORT Castleman disease was diagnosed in a 26-year old male patient when a well defined shadow was incidentally detected in the middle lobe of the right lung. A year before, he was diagnosed with allergic rhinitis to Ambrosia. Two years after surgery the patient was feeling well, and was without any recurrence, however, allergic rhinitis still persisted. CONCLUSION Castleman disease can occur in any organ containing lymph tissues. Most frequently the disease is described as mediastinal, rarely as an intrapulmonary tumorous mass, and it is most frequently seen in younger persons. The solitary type of Castleman disease is surgical treatable with a prospect of good prognosis, while the multicentric and mixed types recur despite treatment with cortisone, irradiation and cytostatics. As the association between Castleman disease and allergic diseases has not been confirmed up-to-now, it could be concluded that this patient suffered from two separated diseases.
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41
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Song MK, Seol YM, Park YE, Kim YS, Lee MK, Lee CH, Jeong YJ. Pulmonary nodular lymphoid hyperplasia associated with Sjögren's syndrome. Korean J Intern Med 2007; 22:192-6. [PMID: 17939337 PMCID: PMC2687695 DOI: 10.3904/kjim.2007.22.3.192] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Pulmonary nodular lymphoid hyperplasia (NLH) is a term first suggested by Kradin and Mark to describe one or more pulmonary nodules or localized lung infiltrates consisting of reactive lymphoid proliferation. To date, there have been only a few cases of pulmonary NLH reported associated with autoimmune disorders. There is no case of NLH associated with Sjögren's syndrome from Korea in the medical literature. A 56-year-old woman was referred to our hospital with cough productive of sputum and chest tightness. The Computed tomography scans of the chest revealed multiple and well-defined peribronchiolar nodular opacities. A video assisted thoracoscopic surgery (VATS) biopsy was performed and the nodular opacity in the lung parenchyma was pathologically confirmed as NLH. Through meticulous review of patient's record, we found that she had been suffering from dry eye and dry mouth. The symptoms suggested Sjögren's syndrome, which was confirmed by specific laboratory tests including the Schirmer test, anti-nuclear antibody and anti-Ro/La antibody. The patient is followed regularly and has no further progression of symptoms.
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Affiliation(s)
- Moo-Kon Song
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
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42
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Thomas H, Risma KA, Graham TB, Brody AS, Deutsch GH, Young LR, Joseph PM. A Kindred of Children With Interstitial Lung Disease. Chest 2007; 132:221-30. [PMID: 17625084 DOI: 10.1378/chest.06-2476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Childhood interstitial lung disease (ILD) is a spectrum of diseases including many different rare lung conditions. We present a family with an unusual presentation of ILD in association with rheumatologic and immunologic abnormalities. METHODS Eight children with a common father were evaluated for evidence of lung disease in association with rheumatologic findings. All underwent routine history and physical examination, hematologic evaluation, and chest radiography and/or CT scan of the chest. Seven children underwent a more extensive immunologic evaluation. Those who were able underwent pulmonary function testing, and four children underwent lung biopsy. RESULTS Six of eight children with a common father were found to have radiographic findings consistent with ILD. These children also had evidence of autoimmune disease with joint symptoms, alopecia, rheumatoid factor production, and hypergammaglobulinemia. Open-lung biopsy in four children revealed a spectrum of pulmonary lymphoid proliferations ranging from reactive lymphoid hyperplasia to lymphoid interstitial pneumonia. CONCLUSION The findings of ILD and autoimmunity in a kindred of children suggest a novel genetic disorder of autosomal dominant pattern and variable penetrance. Although the precise pathogenesis remains unclear, these cases provide valuable insight into childhood ILD.
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Affiliation(s)
- Heather Thomas
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Cincinnati, OH 45267-0564, USA
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44
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Exley CM, Suvarna SK, Matthews S. Follicular bronchiolitis as a presentation of HIV. Clin Radiol 2006; 61:710-3. [PMID: 16843757 DOI: 10.1016/j.crad.2006.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2005] [Revised: 01/18/2006] [Accepted: 03/20/2006] [Indexed: 11/29/2022]
Affiliation(s)
- C M Exley
- Department of Diagnostic Imaging, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, South Yorkshire, UK
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45
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Abstract
Primary pulmonary lymphoma (PPL) is a rare disease with a favorable prognosis compared with lung cancer. Although a number of histologic variables of B- and T-cell lymphoma were reported as PPL, marginal zone lymphoma of the mucosa-associated lymphoid tissue type is by far the most frequent diagnosis. This review summarizes the present knowledge of histopathology, molecular biology, diagnosis, prognosis, and treatment of this heterogeneous entity.
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Affiliation(s)
- Luciano Wannesson
- Department of Medical Oncology, Institute of Southern Switzerland, Bellinzona, Switzerland
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