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Lung tumor

Lymphoma and lymphoid infiltrates

Lymphomatoid granulomatosis


Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 22 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Also called angioimmunoproliferative lesion
● Lymphoproliferative disorder that is malignant per se or likely to become malignant, resembles post-transplant lymphoproliferative disorders

Clinical features
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● Middle aged men and women with well defined, bilateral rounded mass densities on chest Xray
● Associated with transplant-related immunosuppression, Sjogren’s syndrome, HIV
● 80% of cases have extrapulmonary involvement (skin, CNS, kidneys, liver, spleen, adrenal glands, heart, GI tract); rarely, there is only extrapulmonary involvement
● Usually no hilar or mediastinal lymph node involvement
● May be an EBV related, B cell proliferation; T cells present are usually reactive; may have reversal of T helper / suppressor ratio
● Large number of atypical lymphoid cells is a poor prognostic factor
● Median survival 14 months; death due to sepsis, destruction of lung tissue

Treatment
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● Chemotherapy

Micro description
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● Nodular inflammatory infiltrate of large atypical lymphoid cells (prominent nuclei, mitotic activity), plasma cells, immunoblasts, involving walls of pulmonary vessels (angioinvasive, angiocentric, angiodestructive)
● No multinucleated giant cells
● Similar infiltrates found in other organs

Positive stains
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● EBV (50-70%)

Differential diagnosis
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Wegener’s granulomatosis: giant cells, necrosis

End of Lung tumor > Lymphoma and lymphoid infiltrates > Lymphomatoid granulomatosis


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