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Lymphocytic infiltrations of the lung 

Lymphocytic infiltrations of the lung

Chapter:
Lymphocytic infiltrations of the lung
Author(s):

D.J. Hendrick

DOI:
10.1093/med/9780199204854.003.181403

July 30, 2015: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Updated:

A relevant case history from Oxford Case Histories in Respiratory Medicine has been added to this chapter.

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date: 23 April 2017

Many disorders are associated with lymphocytic infiltration of the lung, but there is a spectrum of conditions in which such infiltration is the chief focus of attention, ranging from benign (e.g. lymphocytic interstitial pneumonia) to malignant (e.g. lymphoma).

Lymphocytic interstitial pneumonia—characterized by diffuse infiltration of the lung interstitium and alveolar walls with small mature lymphocytes, immunoblasts, and plasma cells. May be idiopathic or associated with other disease (autoimmune, HIV infection, Epstein–Barr virus infection) or drug hypersensitivity. Radiographic features are of diffuse interstitial shadowing. Open biopsy is generally required for definitive diagnosis. Usually progresses slowly. May respond to corticosteroids.

Lymphomas—apparent ‘primary’ lymphomas of the lung generally fall into three categories: (1) lymphomatoid granulomatosis—systemic symptoms usually dominant, pulmonary lesions usually discrete and nodular, cure requires cytotoxic therapy for lymphoma; (2) low-grade B-cell non-Hodgkin’s lymphoma—the commonest primary lymphoma affecting the lung parenchyma, usually arises from mucosa-associated lymphoid tissue (MALT) of the bronchi, presents with one or more pulmonary nodules, systemic symptoms unusual; and (3) high-grade B-cell non-Hodgkin’s lymphoma—commonly occurs in association with immunosuppression (AIDS, organ transplantation), likely to have respiratory and systemic symptoms.

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