J Rheum Dis.  2019 Jul;26(3):206-210. 10.4078/jrd.2019.26.3.206.

Follicular Bronchiolitis Mimicking Lung Cancer in a Patient with Primary Sjögren's Syndrome

• Shin S
• Ha YJ
• Kang EH
• Song YW
• Lee YJ

• KMID: 2451513
• DOI: http://doi.org/10.4078/jrd.2019.26.3.206

Abstract

Follicular bronchiolitis (FB) is an uncommon pulmonary lymphoproliferative disorder that is characterized by the presence of peribronchiolar hyperplastic lymphoid follicles with reactive germinal centers. FB could be associated with systemic illnesses including immunodeficiency, infection, and autoimmune diseases. In Korea, a single case of FB with rheumatoid arthritis was recently described but there has been no report on FB associated with other rheumatic diseases. Herein, we describe the first case of FB presenting nodular ground-glass opacities (GGO), which mimicked lung cancer, in patients with primary Sjögren's syndrome (SS). The differential diagnosis of nodular GGO lesions should include FB although it is a rare manifestation in SS patients.

Keyword

Sjögren's syndrome; Lung neoplasms; Lung diseases; Interstitial; Bronchiolitis

MeSH Terms

Arthritis, Rheumatoid
Autoimmune Diseases
Bronchiolitis*
Diagnosis, Differential
Germinal Center
Humans
Korea
Lung Diseases
Lung Neoplasms*
Lung*
Lymphoproliferative Disorders
Rheumatic Diseases

Figure

• 

  Figure 1 Serial follow-ups of chest computed tomography (CT). (A) Chest CT showed a nodular ground-glass opacity (GGO) lesion in the left upper lobe, 31 months prior to admission. (B) Seven months prior to admission, the longitudinal diameter of the nodular GGO lesion was slightly increased (from 13.5 to 15.0 mm over 24 months).

• 

  Figure 2 Chest computed tomography (CT) and positron emission tomography (PET)-CT images. (A) Matched CT and PET/CT scan slices demonstrated a 15 mm-sized lesion of nodular ground-glass opacities (GGO) without pathological uptake of 18F-fluorodeoxyglucose in the anterior segment of the left upper lobe. (B) Chest CT scan images revealed a new GGO nodule in the superior segment of the right lower lobe and the corresponding PET-CT slice showed the lesion with hypermetabolism (maximal standardized uptake value 2.1).

• 

  Figure 3 Pathology of lung biopsy specimen. In hematoxylin and eosin stained section, peribronchiolar lymphoid hyperplasia with polymorphous lymphoid populations was observed (A, ×100). Additionally, the destruction of peribronchial alveolar septa was not shown (B, ×100). Immunohistochemistry study for CD3 (C) and CD20 (D) showed that most mononuclear cells were nonmalignant B cells in the peribronchial follicular lymphoid hyperplasia (×40).

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