Four cases of pediatric Acquired Immune Deficiency Syndrome (AIDS) with lymphoproliferative disorder are described and other lymphoid lesions in previously reported cases of pediatric AIDS are reviewed. The lymphoproliferative disorder was characterized by polyclonal, polymorphic B-cell content without evidence of cellular atypia, necrosis or prominent mitotic activity but with predominantly extranodal systemic and prominent pulmonary involvement. Since the lesion has overlapping features it is considered to be intermediate between benign and malignant lymphoproliferations and designated as polyclonal, polymorphic B-cell lymphoproliferative disorder (PBLD) of pediatric AIDS. The PBLD is part of a spectrum of lymphoid lesions in pediatric AIDS consisting of follicular lymphoid hyperplasia of nodal and extranodal sites, pulmonary lymphoid hyperplasia/lymphoid interstitial pneumonitis complex (PLH/LIP complex) in cases previously reported by the authors, and also malignant lymphoma reported by others. It is possible that Epstein-Barr virus (EBV) by itself or in synergism with human T-lymphotropic virus-type III (HTLV-III) is related to pathogenesis of PBLD in children with AIDS.
Chronic reactive bronchiolar obstruction has not been noted to occur with repeated aspiration of food materials. In this report, we describe two autopsy cases of children aged 8 years and 22 months with cerebral palsy, one with documented and treated esophageal reflux, and both with histories of repeated aspiration pneumonia. In each case, the lungs showed multiple nodules of hyalinized tissue and organized exudate obstructing the bronchiolar lumina, with multinucleated foreign body-type giant cells surrounding intraluminal vegetable particles. It is suggested that chronic bronchiolar obstruction was a significant contributing cause of respiratory insufficiency and consequent morbidity in these patients with cerebral palsy.
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