Pulmonary Nodular Lymphoid Hyperplasia

Abstract

Pulmonary nodular lymphoid hyperplasia is an uncommon reactive lymphoproliferative disorder that presents as an asymptomatic lung mass. The histopathologic diagnosis of pulmonary nodular lymphoid hyperplasia may be challenging because of its morphologic overlap with other diseases, such as extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and immunoglobulin G4-related sclerosing disease. Despite the similarities, there are distinctive morphologic and phenotypic features that allow for the correct diagnosis in the majority of cases. This review aims to discuss the clinicopathologic features of pulmonary nodular lymphoid hyperplasia and contrast them with its histopathologic mimickers.

Pulmonary Nodular Lymphoid Hyperplasia in the Eye of Radial Endobronchial Ultrasound

“…MALT lymphoma is distinguished histologically by light chain restriction and Dutcher bodies [1], both of which were not seen in our patient's sample. Meanwhile, IgG4-RSD presents more commonly as multiple lung nodules alongside multiorgan involvement [1], in contrast to the asymptomatic presentation of SPN in our patient. Histologically, IGG4-RSD presents as a lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells with occasional eosinophils and vasculitic features [1].…”

“…However, definite diagnosis of PNLH is often difficult due to overlapping histopathological features and paucity of data regarding its clinical course and the utility of FDG PET/CT in confirming PNLH [2]. MALT lymphoma is distinguished histologically by light chain restriction and Dutcher bodies [1], both of which were not seen in our patient's sample. Meanwhile, IgG4-RSD presents more commonly as multiple lung nodules alongside multiorgan involvement [1], in contrast to the asymptomatic presentation of SPN in our patient.…”

“…The differential diagnoses of PNLH include B cell lymphomas such as marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) and immunoglobulin (Ig) G4-related sclerosing disease (IgG4-RSD) [1]. However, definite diagnosis of PNLH is often difficult due to overlapping histopathological features and paucity of data regarding its clinical course and the utility of FDG PET/CT in confirming PNLH [2].…”

“…Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare, benign lymphoproliferative disorder which can present as a solitary pulmonary nodule (SPN) often in the subpleural or peribronchial region 10 . The diagnosis of PNLH is challenging due to histopathological overlap with other diseases like extranodal marginal zone lymphoma of MALT and IgG4related sclerosing disease [1]. Diagnostic surgical resection remains the mainstay of PNLH diagnosis and management [1][2][3], but advanced bronchoscopic tools like virtual navigation, R-EBUS, and cryobiopsy may enable diagnosis while preventing further invasive intervention.…”

“…The diagnosis of PNLH is challenging due to histopathological overlap with other diseases like extranodal marginal zone lymphoma of MALT and IgG4related sclerosing disease [1]. Diagnostic surgical resection remains the mainstay of PNLH diagnosis and management [1][2][3], but advanced bronchoscopic tools like virtual navigation, R-EBUS, and cryobiopsy may enable diagnosis while preventing further invasive intervention. We report an adult patient who presented with incidental finding of a SPN, and was subsequently diagnosed with PNLH via a combined technique of radial-endobronchial ultrasound (R-EBUS), virtual bronchoscopic navigation (VBN), and cryobiopsy.…”