Figures
- Figure 1.
a) 18-fluorodeoxyglucose positron emission tomography-computed tomography in a 72-year-old male revealed pulmonary nodules in the lower lobes. Surgical lung biopsy of the consolidation in the right lower lobe revealed lymphomatoid granulomatosis. b) Lymphomatoid granulomatosis histopathological specimen in the same patient showing a well-demarcated cellular nodule with a central area of necrosis (asterisk). The preserved alveolar parenchyma is shown in the lower part of the image, below the dashed line. c) The angiocentric nature of the lesion.
- Figure 2.
a) An axial multidetector computed tomography scan in a 43-year-old female, demonstrating consolidations with air bronchograms. b) Transbronchial biopsy of the consolidation revealed Hodgkin lymphoma. c) Immunophenotypic analysis revealed strong expression of activation markers (CD30).
Tables
- Table 1. Classification system for the pulmonary lymphoproliferative disorders
Spectrum of pulmonary lymphoproliferative disorders Reactive pulmonary lymphoid diseases Follicular bronchiolitis Nodular lymphoid hyperplasia (pulmonary pseudo-lymphoma) Lymphocytic interstitial pneumonia Castleman’s disease Localised (hyaline-vascular, plasma cell type) Multicentric Primary pulmonary lymphoma B-cell primary pulmonary non-Hodgkin lymphoma (MALT lymphoma) Primary pulmonary diffuse large B-cell lymphoma Lymphomatoid granulomatosis Follicular lymphoma Mantle cell lymphoma Extra-osseous plasmacytoma Intravascular large B-cell lymphoma Large B-cell lymphoma Plasmoblastic lymphoma T-/NK-lymphoma Anaplastic large cell lymphoma Hodgkin lymphoma Post-transplantation lymphoproliferative disorders MALT: mucosa-associated lymphoid tissue; NK: natural killer cell.
- Table 2. Clinical profile and laboratory syndromes: red flags for clinicians
Asymptomatic lesions MALT lymphoma Serum para-proteins and/or increased LDH Collagen-vascular disease MALT lymphoma in collagen-vascular disorders (e.g. Sjögren) Immunodeficiency Lymphomatoid granulomatosis in HIV Lymphomatoid granulomatosis in Wiskott–Aldrich syndrome Transplantation Post-transplant lymphoproliferative processes Respiratory symptoms T-cell lymphomas Lymphopenia and/or eosinophilia Granulomatous mycosis fungoides Hodgkin lymphoma Thromboembolism Intravascular lymphoma Acute pulmonary hypertension-like onset Increased LDH and/or hypercalcaemia Haemophagocytic syndrome# NK-/T-cell lymphoma, nasal type T-cell lymphoma Organising pneumonia Hodgkin lymphoma Lymphomatoid granulomatosis Treatment with methotrexate, natalizumab or other drugs Atypical lymphoproliferative processes MALT: mucosa-associated lymphoid tissue; LDH: lactate dehydrogenase; NK: natural killer cell. #: abrupt onset, increased triglycerides, increased ferritin, coagulation abnormalities, increased transaminases, and decreased fibrinogen and cytopenia/pancytopenia.
- Table 3. Summary of the computed tomography features in the malignant spectrum of pulmonary lymphoproliferative disorders
Lymphoproliferative lung disorders Computed tomography features MALT lymphoma Nodules or consolidation Peribronchovascular Multiple/bilateral (70%) Hilar/mediastinal nodes (30%) Ground-glass attenuation (halo sign) Rarely cysts, pleural effusion, tree-in-bud High-grade primary large pulmonary B-cell lymphomas Nodule or mass cavitation in 50% Rarely pleural effusion Lymphomatoid granulomatosis Bilateral nodules/masses Peribronchovascular Coalescence and/or cavitate Pleural effusion (30%) Hilar adenopathies (<25%) Migratory Uncommon: single nodules, alveolar opacities and reticulonodular diffuse lesions Follicular lymphoma Ground-glass opacities (crazy paving) Nodules Intravascular large B-cell lymphoma Bilateral reticular shadows Reticulonodular or nodular shadows Ground-glass opacities Wedge-shaped subpleural opacities Pleural effusion Nasal-type T-/NK-lymphomas Nodules or excavated masses Pleural effusion Anaplastic large cell lymphoma, T-cell type Masses or single nodules Mycosis fungoides Nodules with halo signs Peripheral consolidation Crazy paving pattern Primary pulmonary Hodgkin disease Solitary mass or multinodular disease Air bronchograms or cavitation Pleural effusion, lymphadenopathy MALT: mucosa-associated lymphoid tissue; NK: natural killer cell.
