Vol 81, No 1 (2013)
CASE REPORTS
Published online: 2012-12-13
Submitted: 2013-02-22
Nodular lymphoid hyperplasia — a rare case of lymphoproliferative disorder of the lungs
Paweł Rogoziński, Krzysztof Bruliński, Eugeniusz Malinowski, Piotr Wandzel, Marek Kucharzewski
Pneumonol Alergol Pol 2013;81(1):68-72.
Vol 81, No 1 (2013)
CASE REPORTS
Published online: 2012-12-13
Submitted: 2013-02-22
Abstract
Nodular lymphoid hyperplasia (NLH) belongs to a very rare, mild, lymphoproliferative disease of unestablished aetiology
historically included in the group of pseudolymphomas. Its existence was controversial for many years, until modern
techniques of pathomorphological diagnosis approved it as a separate entity of lung disease. It manifests in the form of well
limited nodules localized in the lungs, which are mostly identified accidentally. Clinical symptoms are rare and nonspecific;
the disease usually occupies only one lung. Pathomorphological diagnosis requires immunohistochemical designation of
expressions of numerous antigens in order to exclude malignant lymphoma of the lungs. Surgical resection is used in cases
of larger nodules; the smaller ones require periodic observation, and the prognosis is good. The authors describe the case of
65-year-old woman with pulmonary nodules which were detected accidentally in the right lung. The patient was qualified for
right-sided videothoracoscopy and removal of the lung nodule. In classic HE staining of the histological material, the
presence of lymphoid infiltration of the lungs was revealed, which formed lymph follicles with reactive germinal centres.
In order to differentiate from the malignant lymphatic expansion, immunohistochemical designations were made, which
showed positive expression of CD20 antigen in the B cell zone, positive expression of the CD3 antigen in the T cells zone,
positive expression of CD23 antigen in the lymph follicles, negative expression of bcl-2 in the lymph follicles, and positive
expression of MIB-1 in the germinal centres of lymph follicles. Such a histopathological and immunohistochemical picture
provided the basis for diagnosis of nodular lymphoid hyperplasia of the lung.
Abstract
Nodular lymphoid hyperplasia (NLH) belongs to a very rare, mild, lymphoproliferative disease of unestablished aetiology
historically included in the group of pseudolymphomas. Its existence was controversial for many years, until modern
techniques of pathomorphological diagnosis approved it as a separate entity of lung disease. It manifests in the form of well
limited nodules localized in the lungs, which are mostly identified accidentally. Clinical symptoms are rare and nonspecific;
the disease usually occupies only one lung. Pathomorphological diagnosis requires immunohistochemical designation of
expressions of numerous antigens in order to exclude malignant lymphoma of the lungs. Surgical resection is used in cases
of larger nodules; the smaller ones require periodic observation, and the prognosis is good. The authors describe the case of
65-year-old woman with pulmonary nodules which were detected accidentally in the right lung. The patient was qualified for
right-sided videothoracoscopy and removal of the lung nodule. In classic HE staining of the histological material, the
presence of lymphoid infiltration of the lungs was revealed, which formed lymph follicles with reactive germinal centres.
In order to differentiate from the malignant lymphatic expansion, immunohistochemical designations were made, which
showed positive expression of CD20 antigen in the B cell zone, positive expression of the CD3 antigen in the T cells zone,
positive expression of CD23 antigen in the lymph follicles, negative expression of bcl-2 in the lymph follicles, and positive
expression of MIB-1 in the germinal centres of lymph follicles. Such a histopathological and immunohistochemical picture
provided the basis for diagnosis of nodular lymphoid hyperplasia of the lung.
Keywords
lung; nodular lymphoid hyperplasia (NLH); pseudolymphoma
Title
Nodular lymphoid hyperplasia — a rare case of lymphoproliferative disorder of the lungs
Journal
Advances in Respiratory Medicine
Issue
Vol 81, No 1 (2013)
Pages
68-72
Published online
2012-12-13
Bibliographic record
Pneumonol Alergol Pol 2013;81(1):68-72.
Keywords
lung
nodular lymphoid hyperplasia (NLH)
pseudolymphoma
Authors
Paweł Rogoziński
Krzysztof Bruliński
Eugeniusz Malinowski
Piotr Wandzel
Marek Kucharzewski