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Pulmonary Eosinophilia
Published in Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley, Diagnostic Pulmonary Pathology, 2008
The differential diagnosis of primary pulmonary Hodgkin’s disease includes Non-Hodgkin’s lymphoma, lymphomatoid granulomatosis, Wegener’s granulomatosis, granulomatous infections, and pulmonary Langerhans cell histiocytosis. Non-Hodgkin’s lymphoma may involve the lungs as single or multiple nodules and appear similar histologically to primary pulmonary Hodgkin’s disease. Use of immunohistochemical stains for Reed-Sternberg cells including CD30, CD15, and stains for B- and T-cell lymphomas including CD20, CD45, and CD45RO are often helpful in making this distinction (145). Lymphomatoid granulomatosis may be difficult to distinguish from Hodgkin’s disease. The atypical cells in lymphomatoid granulomatosis, however, unlike Reed-Sternberg cells will stain positively for B-cell markers in most cases (146). Although Wegener’s granulomatosis and Hodgkin’s disease may have areas of geographic necrosis, vascular involvement, granulomatous inflammation, and prominent numbers of eosinophils, Wegener’s granulomatosis lacks Reed-Sternberg cells required for diagnosis of Hodgkin’s disease. The absence of nasopharyngeal and renal involvement, and absence of serum C-ANCA also help to exclude Wegener’s granulomatosis (139). While granulomatous infections may accompany Hodgkin’s disease, those cases unassociated with Hodgkin’s disease will lack Reed-Sternberg cells. The etiologic organism may also be identified on special stains or culture. While the nodules of pulmonary Langerhans cell histiocytosis may superficially resemble primary pulmonary Hodgkin’s disease, the Langerhans cells of pulmonary Langerhans cell histiocytosis may be separated from Reed-Sternberg cells by their distinctive morphology, and positive staining for S100, langerin, and CD1a (12,13,63–66).
Lymphomatoid Granulomatosis in a 14-Year-Old Boy with Trisomy 21 and History of B-Lymphoblastic Leukemia/Lymphoma
Published in Fetal and Pediatric Pathology, 2018
Anna Paulina Matynia, Sherrie L. Perkins, David Li
Lymphomatoid granulomatosis is a lymphoproliferative disorder involving predominantly extranodal sites. It affects mostly adults with underlying immunodeficiency, including various primary immunodeficiency syndromes (e.g., common variable immunodeficiency, X-linked agammaglobulinemia and hypogammaglobulinemia) and acquired immunodeficiency states, such as human immunodeficiency virus (HIV) infection. The WHO also lists allogeneic organ transplantation as a predisposing condition; however, the debate exists if the diagnosis of LYG versus post-transplant lymphoproliferative disorder should be made in this setting (2,4). Similarly, it is not entirely clear if the diagnosis of LYG versus iatrogenic immunodeficiency-associated lymphoproliferative disorder should be made in patients treated with immunosuppressive therapy (e.g., methotrexate) presenting with pulmonary disease, since the histopathologic features of both disorders are similar. Interestingly, LYG has been reported only infrequently following diagnosis and/or treatment of hematopoietic malignancy, although this state is associated with at least temporary and relative immunosuppression. EBV plays an important role in the etiology and is usually identified in tissue sections. LYG in the pediatric population is very uncommon, and our case illustrates one of the few associated with a prior hematologic malignancy and ongoing maintenance chemotherapy.
Early Identification of Fungal and Mycobacterium Infections in Pulmonary Granulomas Using Metagenomic Next-Generation Sequencing on Formalin fixation and paraffin embedding tissue
Published in Expert Review of Molecular Diagnostics, 2022
Wenwen Sun, Zhengwei Dong, Yiming Zhou, Kunlong Xiong, Hongcheng Liu, Zhemin Zhang, Lin Fan
Eighty-two FFPE specimens that underwent surgery were pathologically indicated granulomas, and 13 cases were not included in the statistical analysis because they were positive on rapid etiology tests/cytology on fresh biopsy specimens or unqualified tissue specimens. Among 69 cases finally enrolled, 41 (59.42%, 41/69) cases were diagnosed as infectious granuloma with clinical diagnosis as the reference standard, 18 (26.09%, 18/69) cases were diagnosed as noninfectious granulomas through histopathology and immunohistochemistry (12 sarcoidosis, 3 lymphomatoid granulomatosis, 2 GPA, and 1 PLCH). The resting 10 (14.49%) cases with diagnostic uncertainty were followed up for half a year, and the imaging and clinical conditions were stable (Figure 1).
An atypical case of a pulmonary mass in an immunocompromised patient
Published in Acta Clinica Belgica, 2020
Nina Cardinaels, Winand Van Rompaey, Saskia Bos, Hannelore Bode, Thomas Tousseyn, Pascal Van Bleyenbergh
The decision to start treatment depends on the extent of pulmonary involvement and histopathologic grade, the symptomatology of the patients and the use of medications associated with PLG [14]. In this particular patient, however, cessation of Azathioprine and treatment with Rituximab led to disease remission which makes this particular case in fact a ‘drug induced PLG’ or ‘iatrogenic immunodeficiency-associated lymphoproliferative disorder’. These disorders mimic lymphoid granulomatosis grade II and III in the lungs but should not be diagnosed as pulmonary lymphomatoid granulomatosis because of the different therapeutic implications as shown in this case where withdrawal of the immunosuppressive agent can lead to disease regression.