Lymphocytic interstitial pneumonia presenting with a ground glass nodule: A case report and literature review

Abstract

Rationale: Lymphocytic interstitial pneumonia (LIP) is a rare benign lymphoproliferative disorder, often associated with autoimmune diseases. Most LIPs present with multiple bronchial cysts and diffuse interstitial infiltration. It is histologically characterized by widespread diffuse lymphocytic infiltration of the pulmonary interstitium, and the enlargement and widening of the alveolar septum. Patient concerns: A 49-year-old woman was admitted to hospital for finding pulmonary nodules for more than 2 months. 3D imaging chest computed tomography (CT) examination of both lungs showed that there was a middle lobe of the right lung with a size of about 1.5 cm × 1.1 cm ground-glass nodules. Diagnoses: A single operating port thoracoscopic wedge resection biopsy of a right middle lung nodule was performed. The pathology showed diffuse lymphocytic infiltration with varying numbers of small lymphocytes, plasma cells, macrophages and histiocytes infiltrating the alveolar septa, widened and enlarged alveolar septa, and scattered lymphoid follicles. Immunohistochemically, CD20 positive in follicular area, CD3 positive in interfollicular area. LIP was considered. Interventions: The patient was regularly followed without any specific treatment. Outcomes: Follow-up chest CT showed no significant abnormalities in the lungs 6 months after surgery. Lessons: To the best of our knowledge, our case may be the second reported case of a patient with LIP presenting with a ground glass nodule on chest CT, and it is speculated that the ground glass nodule may be an early manifestation of idiopathic LIP.

Noninfectious Granulomatous Lung Disease: Radiological Findings and Differential Diagnosis

“…LIP can occur at any age with a mean age of 52-56 years, with a female predilection because women are more likely to develop autoimmune diseases [79,80]. LIP occurs more frequently in people affected by autoimmune disorders or immunodeficiency, such as Sjogren's syndrome, systemic lupus erythematosus, autoimmune thyroid disease, human immunodeficiency virus (HIV) infection, and multicentric Castleman's disease [81].…”

“…LIP is considered a benign lymphoproliferative disorder histologically characterized by diffuse interstitial and alveolar infiltration with polyclonal lymphocytes and plasma cells [82]. In this disease, the inflammatory infiltration of the interstitium by reactive T and B lymphocytes, plasma cells, and histiocytes can be seen, with consequential inflammation of lung parenchyma and bronchi [79,81,83]. The main pathologic feature of LIP is dense interstitial lymphocytic infiltrates, which expand and widen the interlobular and alveolar septa [79,83].…”

“…Radiological findings of LIP may vary widely [81]. Chest X-ray shows nonspecific findings, the most frequent are classically bilateral lower zone reticular or reticulonodular opacity, while less common findings include a nodular pattern, GGO, and air-space consolidation [86].…”