Pulmonary lymphomatoid granulomatosis mimicking lung cancer

Bartosik, Waldemar; Raza, Ali; Kalimuthu, Sangeetha; Fabre, Aurélie

doi:10.1093/icvts/ivr083

Cited by 13 publications

(11 citation statements)

References 5 publications

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“…Radiographically LYG usually presents as bilateral pulmonary nodules [2] . Rare cases of pulmonary LYG presenting as a single mass or masquerading as a lung abscess are reported [12,10] . Grade 3 LYG lesions have large areas of necrosis that can be misleading into the radiographic diagnosis of carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Grade 3 LYG lesions have large areas of necrosis that can be misleading into the radiographic diagnosis of carcinoma. Resections of unilateral masses of pulmonary LYG that were radiographically compatible with carcinoma have been reported [12] . Therefore, it is imperative to have LYG in the differential diagnosis during radiographic evaluation of a solitary lung mass.…”

Section: Discussionmentioning

confidence: 99%

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Lymphomatoid Granulomatosis: Rare Radiologic Presentation as a Solitary Pulmonary Mass

Shestakova

Gallegos

Wang

et al. 2019

IJCO

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Background: Lymphomatoid granulomatosis (LYG) is a rare Epstein-Barr virus (EBV)-driven lymphoproliferative disease. LYG is characterized by a progressive clinical course, which virtually always involves the lungs. LYG characteristically presents as bilateral pulmonary nodules. Pathologically, it is characterized by an angiocentric and angiodestructive infiltration of atypical EBV-positive B-lymphocytes admixed with reactive T-lymphocytes. We report a case of pulmonary LYG that presented as a large mass with complete occlusion of the right main stem bronchus intermedius in an 81-year-old female. Case: An 81-year-old female presented with shortness of breath to the emergency department. Inpatient imaging revealed bulky mediastinal lymphadenopathy with a right lower lobe collapse, shift of the cardiomediastinal silhouette, and a large right upper lung mass. Endobronchial ultrasound-guided biopsy (EBUS) revealed complete occlusion of right mainstem bronchus due to the right upper lung mass growth into the bronchus intermedius. Histopathological examination demonstrated clusters of large atypical EBV-positive B cells interspersed in a minimally polymorphous lymphocytic background, consistent with lymphomatoid granulomatosis, grade 3/3. Patient was treated with immunochemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone - CHOP) and Rituximab (anti-CD20 antibody). At the patient’s most recent follow-up, 6 months later, she was in a stable condition and her respiratory symptoms have improved. Conclusion: Lymphomatoid granulomatosis is a rare disease that should be considered in the differential diagnosis of a radiographic evaluation of a solitary pulmonary lung mass. Since the radiographic impression might favor carcinoma as the top differential diagnosis, biopsy of the lesion is paramount to ensure the correct diagnosis. Lymphomatoid granulomatosis is usually treated with an immunochemotherapy regimen with CHOP, and/or interferon, and Rituximab.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lymphomatoid Granulomatosis: Rare Radiologic Presentation as a Solitary Pulmonary Mass

Shestakova

Gallegos

Wang

et al. 2019

IJCO

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“…18 F-FDG PET/CT findings vary considerably. Reports in the literature describe a single 18 F-FDG-avid nodule, 5 few mildly 18 F-FDG-avid nodules, 6 a large cavitating 18 F-FDG-avid mass, 7 , 8 multiple cavitating masses 9 and numerous fluffy nodules. 10 Staging, evaluation of response to therapy and long-term follow-up of LYG patients with 18 F-FDG PET/CT has not been previously described in the literature and warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

Cerebral and pulmonary lymphomatoid granulomatosis and EBV positive oesophageal ulcer in an immunosuppressed renal transplant patient staged and followed with serial MRI and ¹⁸F-FDG PET/CT after rituximab therapy

Makis¹,

Deschênes²

2016

BJR|case reports

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Lymphomatoid granulomatosis is a rare Epstein–Barr virus-related lymphoproliferative disorder. We describe a case of a 42-year-old female with lupus nephritis and immunosuppression post renal transplant, who was diagnosed with central nervous system and lung lymphomatoid granulomatosis, as well as an Epstein–Barr virus-positive oesophageal ulcer, and was staged and followed up long term with multiple 18F-fludeoxyglucose positron emission tomography/CT scans and brain MRIs after achieving a complete metabolic response with rituximab.

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“…Other manifestations of PLG in the literature include a large necrotic tumor in the left upper lobe [10], idiopathic interstitial pneumonia [2], a solitary lung nodule [11] or mass [12, 13], and a lung abscess [14]. …”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of a Rare Disease: Pulmonary Lymphomatoid Granulomatosis

Mohyuddin

Sultan

Khaleeq

2012

Case Reports in Pulmonology

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A 70-year-old female presented with a 4-week history of dry cough and wheezing. Chest radiograph showed a 10.5 cm mass-like density in the anterior mediastinum which had not been previously visualized. Computed tomography scan (CT) of the chest showed a right hilar mass encasing and narrowing right upper lobe bronchus and right mainstem bronchus and secondary atelectatic changes. Biopsy was consistent with a diagnosis of lymphomatoid granulomatosis Grade 3. She responded well clinically and radiologically to therapy. Lymphomatoid granulomatosis is a rare EBV-associated disorder which is considered a lymphoproliferative disease. The most common radiographic feature is multiple lung nodules. An isolated hilar mass is an exceptionally rare presentation of this rare disease.

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Pulmonary lymphomatoid granulomatosis mimicking lung cancer

Abstract: Lymphomatoid granulomatosis (LYG) of the lung is an extremely rare, Epstein-Barr virus-related lymphoproliferative disease. We report a case of pulmonary LYG that presented as a large necrotic mass.

Cited by 13 publications

References 5 publications

Lymphomatoid Granulomatosis: Rare Radiologic Presentation as a Solitary Pulmonary Mass

Lymphomatoid Granulomatosis: Rare Radiologic Presentation as a Solitary Pulmonary Mass

Cerebral and pulmonary lymphomatoid granulomatosis and EBV positive oesophageal ulcer in an immunosuppressed renal transplant patient staged and followed with serial MRI and ¹⁸F-FDG PET/CT after rituximab therapy

A Rare Presentation of a Rare Disease: Pulmonary Lymphomatoid Granulomatosis

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Pulmonary lymphomatoid granulomatosis mimicking lung cancer

Abstract: Lymphomatoid granulomatosis (LYG) of the lung is an extremely rare, Epstein-Barr virus-related lymphoproliferative disease. We report a case of pulmonary LYG that presented as a large necrotic mass.

Cited by 13 publications

References 5 publications

Lymphomatoid Granulomatosis: Rare Radiologic Presentation as a Solitary Pulmonary Mass

Lymphomatoid Granulomatosis: Rare Radiologic Presentation as a Solitary Pulmonary Mass

Cerebral and pulmonary lymphomatoid granulomatosis and EBV positive oesophageal ulcer in an immunosuppressed renal transplant patient staged and followed with serial MRI and 18F-FDG PET/CT after rituximab therapy

A Rare Presentation of a Rare Disease: Pulmonary Lymphomatoid Granulomatosis

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Cerebral and pulmonary lymphomatoid granulomatosis and EBV positive oesophageal ulcer in an immunosuppressed renal transplant patient staged and followed with serial MRI and ¹⁸F-FDG PET/CT after rituximab therapy