DOI QR코드

DOI QR Code

Lymphomatoid Granulomatosis: CT and FDG-PET Findings

  • Chung, Jonathan H. (Institute of Advanced Biomedical Imaging, National Jewish Health) ;
  • Wu, Carol C. (Department of Radiology, Massachusetts General Hospital) ;
  • Gilman, Matthew D. (Department of Radiology, Massachusetts General Hospital) ;
  • Palmer, Edwin L. (Department of Radiology, Massachusetts General Hospital) ;
  • Hasserjian, Robert P. (Department of Pathology, Massachusetts General Hospital) ;
  • Shepard, Jo-Anne O. (Department of Radiology, Massachusetts General Hospital)
  • Published : 2011.12.01

Abstract

Objective: Lymphomatoid granulomatosis (LG) is a rare, aggressive extranodal Epstein-Barr virus (EBV)-positive B-cell lymphoproliferative disease. The purpose of our study was to analyze the CT and fluorodeoxyglucose positron emission tomography (FDG-PET) findings of pulmonary LG. Materials and Methods: Between 2000 and 2009, four patients with pathologically proven pulmonary LG and chest CT were identified. Two of these patients also had FDG-PET. Imaging features of LG on CT and PET were reviewed. Results: Pulmonary nodules or masses with peribronchovascular, subpleural, and lower lung zonal preponderance were present in all patients. Central low attenuation (4 of 4 patients), ground-glass halo (3 of 4 patients), and peripheral enhancement (4 of 4 patients) were observed in these nodules and masses. An air-bronchogram and cavitation were seen in three of four patients. FDG-PET scans demonstrated avid FDG uptake in the pulmonary nodules and masses. Conclusion: Pulmonary LG presents with nodules and masses with a lymphatic distribution, as would be expected for a lymphoproliferative disease. However, central low attenuation, ground-glass halo and peripheral enhancement of the nodules/masses are likely related to the angioinvasive nature of this disease. Peripheral enhancement and ground-glass halo, in particular, are valuable characteristic not previously reported that can help radiologists suggest the diagnosis of pulmonary LG.

Keywords

References

  1. Guinee D Jr, Jaffe E, Kingma D, Fishback N, Wallberg K, Krishnan J, et al. Pulmonary lymphomatoid granulomatosis. Evidence for a proliferation of Epstein-Barr virus infected B-lymphocytes with a prominent T-cell component and vasculitis. Am J Surg Pathol 1994;18:753-764 https://doi.org/10.1097/00000478-199408000-00001
  2. Liebow AA, Carrington CR, Friedman PJ. Lymphomatoid granulomatosis. Hum Pathol 1972;3:457-558 https://doi.org/10.1016/S0046-8177(72)80005-4
  3. Dee PM, Arora NS, Innes DJ Jr. The pulmonary manifestations of lymphomatoid granulomatosis. Radiology 1982;143:613-618 https://doi.org/10.1148/radiology.143.3.7079490
  4. Hicken P, Dobie JC, Frew E. The radiology of lymphomatoid granulomatosis in the lung. Clin Radiol 1979;30:661-664 https://doi.org/10.1016/S0009-9260(79)80017-3
  5. Wechsler RJ, Steiner RM, Israel HL, Patchefsky AS. Chest radiograph in lymphomatoid granulomatosis: comparison with Wegener granulomatosis. AJR Am J Roentgenol 1984;142:79-83 https://doi.org/10.2214/ajr.142.1.79
  6. Prenovault JM, Weisbrod GL, Herman SJ. Lymphomatoid granulomatosis: a review of 12 cases. Can Assoc Radiol J 1988;39:263-266
  7. Lee JS, Tuder R, Lynch DA. Lymphomatoid granulomatosis: radiologic features and pathologic correlations. AJR Am J Roentgenol 2000;175:1335-1339 https://doi.org/10.2214/ajr.175.5.1751335
  8. Arai H, Oshiro H, Yamanaka S, Yukawa N, Wada N, Rino Y, et al. Grade I lymphomatoid granulomatosis with increased uptake of [18F] fluorodeoxyglucose in positron emission tomography: a case report. J Clin Exp Hematop 2009;49:39-44 https://doi.org/10.3960/jslrt.49.39
  9. Roarke MC, Nguyen BD. PET/CT characterization and monitoring of disease activity in lymphomatoid granulomatosis. Clin Nucl Med 2007;32:258-259 https://doi.org/10.1097/01.rlu.0000255247.66398.46
  10. Rossi G, Marchioni A, Guicciardi N, Bertolini F, Valli R, Cavazza A. A rare cause of fever and PET-positive nodules in the lungs. Clin Respir J 2009;3:118-120 https://doi.org/10.1111/j.1752-699X.2008.00114.x
  11. Pittaluga S, Jaffe ES. Lymphomatoid granulomatosis. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, eds. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press, 2008:247-249
  12. Katzenstein AL, Carrington CB, Liebow AA. Lymphomatoid granulomatosis: a clinicopathologic study of 152 cases. Cancer 1979;43:360-373 https://doi.org/10.1002/1097-0142(197901)43:1<360::AID-CNCR2820430151>3.0.CO;2-8
  13. Guinee DG Jr, Perkins SL, Travis WD, Holden JA, Tripp SR, Koss MN. Proliferation and cellular phenotype in lymphomatoid granulomatosis: implications of a higher proliferation index in B cells. Am J Surg Pathol 1998;22:1093-1100 https://doi.org/10.1097/00000478-199809000-00008
  14. Yamauchi Y, Yoshizawa A, Kudo K, Okuwaki H, Niino H, Morita T. [A case of lymphomatoid granulomatosis with multiple thin-walled cavities]. Nihon Kokyuki Gakkai Zasshi 2002;40:292-298
  15. Vahid B, Salerno DA, Marik PE. Lymphomatoid granulomatosis: a rare cause of multiple pulmonary nodules. Respir Care 2008;53:1227-1229
  16. Collins J. CT signs and patterns of lung disease. Radiol Clin North Am 2001;39:1115-1135 https://doi.org/10.1016/S0033-8389(05)70334-1
  17. Kimura S, Ashizawa K, Matsuyama N, Kadota J, Kohno S, Hayashi K. [Imaging of Wegener's granulomatosis: changes by serial chest CT]. Nihon Kokyuki Gakkai Zasshi 2002;40:171-176
  18. Wong JS, Weisbrod GL, Chamberlain D, Herman SJ. Bronchioloalveolar carcinoma and the air bronchogram sign: a new pathologic explanation. J Thorac Imaging 1994;9:141-144 https://doi.org/10.1097/00005382-199422000-00004
  19. Kui M, Templeton PA, White CS, Cai ZL, Bai YX, Cai YQ. Evaluation of the air bronchogram sign on CT in solitary pulmonary lesions. J Comput Assist Tomogr 1996;20:983-986 https://doi.org/10.1097/00004728-199611000-00021
  20. Lee YR, Choi YW, Lee KJ, Jeon SC, Park CK, Heo JN. CT halo sign: the spectrum of pulmonary diseases. Br J Radiol 2005;78:862-865 https://doi.org/10.1259/bjr/77712845
  21. Benamore RE, Weisbrod GL, Hwang DM, Bailey DJ, Pierre AF, Lazar NM, et al. Reversed halo sign in lymphomatoid granulomatosis. Br J Radiol 2007;80:e162-166 https://doi.org/10.1259/bjr/46361210

Cited by

  1. Primary diffuse large B-cell lymphoma or lymphomatoid granulomatosis grade 3: a still-puzzling diagnosis in autopsy vol.3, pp.4, 2013, https://doi.org/10.4322/acr.2013.036
  2. Pulmonary lymphomatoid granulomatosis in a 4-year-old girl vol.45, pp.7, 2011, https://doi.org/10.1007/s00247-014-3233-4
  3. Neoplasias hematológicas: interpretación de los hallazgos pulmonares en la tomografía computarizada torácica vol.57, pp.6, 2011, https://doi.org/10.1016/j.rx.2015.07.003
  4. Cerebral and pulmonary lymphomatoid granulomatosis and EBV positive oesophageal ulcer in an immunosuppressed renal transplant patient staged and followed with serial MRI and 18 F-FDG PET/C vol.2, pp.3, 2011, https://doi.org/10.1259/bjrcr.20150503
  5. Approach to Peribronchovascular Disease on CT vol.40, pp.3, 2011, https://doi.org/10.1053/j.sult.2018.12.002
  6. Primary pulmonary lymphoma: imaging findings in 30 cases vol.124, pp.12, 2011, https://doi.org/10.1007/s11547-019-01091-z
  7. Pulmonary Recurrence of Lymphomatoid Granulomatosis Diagnosed on F-18 FDG PET/CT vol.35, pp.2, 2011, https://doi.org/10.4103/ijnm.ijnm_174_19
  8. CT Halo sign: A systematic review vol.124, pp.None, 2011, https://doi.org/10.1016/j.ejrad.2020.108843
  9. Pulmonary lymphomatoid granulomatosis: An uncommon disease but not to be forgotten-a single centre experience vol.9, pp.7, 2011, https://doi.org/10.1002/rcr2.789
  10. An Overview of Selected Rare B-Cell Lymphoproliferative Disorders: Imaging, Histopathologic, and Clinical Features vol.13, pp.22, 2011, https://doi.org/10.3390/cancers13225853