(aka Pulmonary Lymphoid Hyperplasia)

Etiology

• Primary Pulmonary Lymphoid Hyperplasia
• Secondary Pulmonary Lymphoid Hyperplasia
  • Sjogren’s Syndrome (see [[Sjogrens Syndrome]])
  • Rheumatoid Arthritis (see [[Rheumatoid Arthritis]])
  • AIDS (see [[HIV Disease]])
  • Bronchiectasis (see [[Bronchiectasis]])
  • Other Infections

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Physiology

• Infiltration of bronchiolar or bronchial walls by hyperplastic lymhoid follicles with germinal centers (composed of lymphocytes)
• Represents one of the lymphoproliferative disorders of the lungs (along with LIP, MALTomas, and nodular lymphoid hyperplasia/pseudolymphoma

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Pathology

• Lymphoid Hyperplasia: peribronchiolar germinal centers

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Diagnosis

• PFT’s: obstruction (distinct from LIP, which usually produces restriction)
• FOB: lymphocytic-predominant BAL (similar to Sarcoid and HP)
• CXR/Chest CT Pattern
  • Centrilobular Nodules with Peripheral Tree-In-Bud Pattern: characteristic of bronchiolar disease
  • Ground-Glass Opacities:
  • Mediastinal Adenopathy: also seen in LIP and Nodular Lymphoid Hyperplasia

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Clinical

• Centrilobular Nodules + Ground-Glass Infiltrates with Obstructive PFT’s (see [[Obstructive Lung Disease]] and [[ILD-Etiology]])
  • Exertional Dyspnea: typically slowly progressive

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Treatment

• Treat Underlying Condition
• Steroids: effective

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References

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