Tuberc Respir Dis.  2015 Apr;78(2):137-141. 10.4046/trd.2015.78.2.137.

Low Grade Pulmonary Lymphomatoid Granulomatosis with an Endobronchial Mass

• Kim KH
• Park J
• Yoo JY
• Kim MJ
• Kim I
• Rhee CK
• Lee HY

• KMID: 2320608
• DOI: http://doi.org/10.4046/trd.2015.78.2.137

Abstract

Lymphomatoid granulomatosis (LYG) is an angiocentric and angiodestructive neoplastic proliferation of B and T lymphocytes commonly involving the lungs. Epstein-Barr virus is commonly detected in lesional cells. We report a case of a 54-year-old female with underlying monoclonal gammopathy of unknown significance who presented with a 4 week history of dyspnea and cough. Computed tomography scan of the chest showed multiple lung nodules as well as endobronchial narrowing causing atelectasis at the left upper lobe. Bronchoscopic findings revealed obstruction at the lingula segment due to endobronchial mass as a rare presentation. Bronchoscopic biopsy was diagnosed with LYG grade 1. After treatment, the endobronchial mass and lung lesions were completely resolved. However, the patient eventually evolved to malignant lymphoma after 1 year.

Keyword

Lymphomatoid Granulomatosis; Lymphoma

MeSH Terms

Biopsy
Cough
Dyspnea
Female
Herpesvirus 4, Human
Humans
Lung
Lymphoma
Lymphomatoid Granulomatosis*
Middle Aged
Paraproteinemias
Pulmonary Atelectasis
T-Lymphocytes
Thorax

Figure

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  Figure 1 (A) Initial chest posteroanterior image revealing diffuse patchy and nodular densities in the left lower lung. (B, C) Low dose computed tomography scan of chest on admission showing diffused patchy and nodular densities in both lungs and segmental collapse with proximal endobronchial filling defect in left upper lingula segment.

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  Figure 2 Bronchoscopy showing diffused bronchial nodular lesions with hypervascular mucosal changes and luminal narrowing at right upper lobe (A) and left upper lobe lingular division revealing almost near obstruction (B).

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  Figure 3 Pathology of endobronchial biopsy showing infiltration of lymphoid cells, scattered plasma cells, and histiocytes (A) at immunohistochemistry, a background of CD4+ T-cells (B) with CD20+ (C), and large atypical B cells with nuclear positivity for Epstein-Barr virus (EBV)-RNA (D) with EBV-encoded RNA probe after in-situ hybridization.

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  Figure 4 After 8 months of lymphomatoid granulomatosis diagnosis, computed tomography scan of chest showing left upper lobe (LUL) lobar bronchus obstruction and LUL total collapse (A) with bronchoscopy showing total obstruction of LUL bronchus by mass (B).

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  Figure 5 (A, B) Computed tomography scan of chest after cyclophosphamide therapy showing complete regression of endobronchial tumor and atelectasis in left upper lobe as well as multiple lung nodules.

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  Figure 6 (A, B) Positron emission tomography computed tomography showing fludeoxyglucose uptakes in bilateral lower neck, mediastinum, peribronchial, mesentery and retroperitoneum nodes.

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