Pulmonary nodular lymphoid hyperplasia (PNLH) is a type of benign lymphoproliferative disease that can affect the lung.
It can present in any age group although the majority of cases present between 50 and 70 years of age 6.
Most cases are usually asymptomatic and found incidentally on imaging for an unrelated cause. Occasionally, there can be symptoms such as shortness of breath, cough and/or pleuritic chest pain.
Most, if not all, such cases are favoured tp represent extranodal marginal zone B-cell lymphomas masquerading as reactive lesions.
There is usually dense nodular infiltration of mature, polyclonal lymphocytes and plasma cells with multiple reactive germinal centres. These are sharply demarcated from surrounding parenchyma and with central areas of scarring. Foci of organising pneumonia may be commonly seen in the periphery. There can also be mild, local lymphangitic spread of lymphocytes permeating into the perivascular interstitium.
Usually present as a solitary lesion. Described features on HRCT chest include 1:
- well-circumscribed nodular lesion: this can be a solitary pulmonary nodule or focal consolidation with an ~2 cm diameter
- coalescence of two or more nodules can rarely occur to form a discrete mass
- a very mild, focal lymphangitic pattern may be seen
History and etymology
It was initially described as pulmonary pseudolymphoma by S L Saltzstein in 1963 3. The term pulmonary nodular lymphoid hyperplasia was suggested by Kradin and Mark 6.
Imagin differential considerations include
pulmonary lymphoma (especially MALT lymphoma affecting lung)
- nodules tend to be bilateral and multifocal and may show features such as pleural invasion
- 1. Hare SS, Souza CA, Bain G et-al. The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol. 2012;85 (1015): 848-64. Br J Radiol (full text) - doi:10.1259/bjr/16420165 - Free text at pubmed - Pubmed citation
- 2. Kajiwara S, Sakai S, Soeda H et-al. Multifocal nodular lymphoid hyperplasia of the lung. J Thorac Imaging. 2005;20 (3): 239-41. Pubmed citation
- 3. Saltzstein SL. Pulmonary malignant lymphomas and pseudolymphomas Classification, therapy and prognosis. Cancer. 1963;16: 928-55. Pubmed citation
- 4. Karube Y, Chida M, Honma K et-al. Nodular lymphoid hyperplasia: rare case of lymphoproliferative disease in the lung. Gen Thorac Cardiovasc Surg. 2009;57 (6): 324-7. doi:10.1007/s11748-008-0390-0 - Pubmed citation
- 5. Sakurai H, Hada M, Oyama T. Nodular lymphoid hyperplasia of the lung: a very rare disease entity. Ann. Thorac. Surg. 2007;83 (6): 2197-9. doi:10.1016/j.athoracsur.2006.12.051 - Pubmed citation
- 6. Song MK, Seol YM, Park YE et-al. Pulmonary nodular lymphoid hyperplasia associated with Sjögren's syndrome. Korean J. Intern. Med. 2007;22 (3): 192-6. Free text at pubmed - Pubmed citation
- 7. Nakamura H, Miwa K, Haruki T et-al. Multifocal nodular lymphoid hyperplasia of the lung differently identified by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). Thorac Cardiovasc Surg. 2009;57 (07): 439-40. doi:10.1055/s-2008-1038982 - Pubmed citation
- 8. Abbondanzo SL, Rush W, Bijwaard KE et-al. Nodular lymphoid hyperplasia of the lung: a clinicopathologic study of 14 cases. Am. J. Surg. Pathol. 2000;24 (4): 587-97. Pubmed citation
- 9. Song MK, Seol YM, Park YE et-al. Pulmonary nodular lymphoid hyperplasia associated with Sjögren's syndrome. Korean J. Intern. Med. 2007;22 (3): 192-6. Free text at pubmed - Pubmed citation