Lymphoproliferative Disorder



Lymphoproliferative Disorder


Jud W. Gurney, MD, FACR





Key Facts


Terminology



  • Lymphoproliferative disorders strongly related to either autoimmune diseases or immunosuppressed conditions


  • Follicular bronchiolitis



    • Small nodules and mediastinal lymphadenopathy common


  • Lymphocytic interstitial pneumonia (LIP)



    • Thin-walled cysts (80%), may be isolated finding


  • Nodular lymphomatoid hyperplasia



    • Air-space mass (consolidation with air-bronchograms)


  • Inflammatory myofibroblastic tumor



    • Solitary round to ovoid mass 1-12 cm in size


    • Mild homogeneous contrast enhancement


  • Castleman disease



    • Nodes may have intense enhancement (usually hyaline vascular form)


  • Angioimmunoblastic T-cell lymphoma (AILT)



    • Nodes may have avid contrast enhancement


    • Pleural effusion (40%)


  • Post-transplant lymphoproliferative disorder (PTLD)



    • Mediastinal adenopathy (50%), thymic involvement rare but relatively specific


  • Encompasses nonneoplastic and neoplastic lesions


Top Differential Diagnoses



  • Sarcoidosis


  • Hodgkin Lymphoma


  • Non-Hodgkin Lymphoma


Clinical Issues



  • Dysproteinemias clue to underlying lymphoid disorder







Axial CECT shows peripheral ground-glass centrilobular nodules image from follicular bronchiolitis.






Axial HRCT shows centrilobular nodules image and small scattered cysts image in a patient with lymphocytic interstitial pneumonia.


TERMINOLOGY


Definitions



  • Lymphoproliferative disorder (LPD)



    • Encompasses neoplastic and nonneoplastic lesions


    • May regress spontaneously or progress to malignant lymphoma


    • Strongly related to either autoimmune diseases or immunosuppressed conditions


  • Bronchus associated lymphoid tissue (BALT) extends from nodal clusters in airway bifurcations to lymphocyte cluster at proximity of lymphatics in respiratory bronchiole



    • BALT has extensive distribution, positioned to handle a large number of inhaled or circulating antigens


    • Polyclonal proliferation consistent with benign disease; monoclonal proliferation of lymphocytes consistent with lymphoma



      • Clonal groups determined by special stains


  • Specific LPD entities include



    • Follicular bronchiolitis


    • Lymphocytic interstitial pneumonia (LIP)


    • Nodular lymphomatoid hyperplasia (pseudolymphoma)


    • Inflammatory myofibroblastic tumor (plasma cell granuloma or inflammatory pseudotumor)


    • Castleman disease


    • Angioimmunoblastic T-cell lymphoma (AILT)


    • Post-transplant lymphoproliferative disorder (PTLD)


IMAGING FINDINGS


General Features



  • Best diagnostic clue



    • Abnormalities of lymphoid tissue from



      • Mediastinum: Enlarged mediastinal hilar lymph nodes


      • Lung: Thickening bronchovascular vessels, centrilobular nodules, septal thickening


      • LPD entities often focal and do not involve all lymphoid tissue


CT Findings

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Sep 20, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on Lymphoproliferative Disorder

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