Nodular lymphoid hyperplasia

In the other group, all the patients have been adults with a history of susceptibility to infection commencing between 19 and 29 years of age. These patients have presented with diarrhea, some evidence of malabsorption, and infestation with Giardia lamblia. Jejunal biopsy and radiology have revealed nodular lymphoid hyperplasia (H16). This syndrome is also seen with severe hypogammaglobulinemia in surviving adults (K4). Cases with isolated IgA deficiency where the absence of isoagglutinins has raised a suspicion of inadequate IgM are also described. 

The adult group have shown serum IgG levels from 25 to 50% MNA with IgA and IgM deficiency. The chief contrast with the children has been very low or absent isogglutinin titers. Cellular immunity appears to have been normal the nodular lymphoid hyperplasia seems to be a compensation for the humoral inadequacy indeed splenomegaly is also found in half these adults. 

G23. Gryboski, J. D., Self, T. W., Clemett, A., and Herskovic, T., Selective immunoglobulin A deficiency and intestinal nodular lymphoid hyperplasia correction of diarrhoea with antibiotics and plasma. Pediatrics 42, 833-837 (1968). 

K4. Kirkpatrick, C. H., Waxman, D., Smith, O. D., and Schimke, R. N., H3rpogamma-globulinemia with nodular lymphoid hyperplasia of the small bowel. Arch. Intern. Med. 121, 273-277 (1968). 

Nodular lymphoid hyperplasia BALT has replaced the term pseudolymphoma and is characterized by reactive lymphoid proliferation that characteristically shows numerous lymphoid follicles with large germinal centers usually occurring in middle-aged people, most of whom are asymptomatic. Approximately 10% to 15% of patients have a collagen vascular disease such as systemic lupus erythematosus or an immune disease of uncertain etiology, and they frequently exhibit polyclonal gam-mopathy. Polytypic plasma cells are common. Marker studies show a mixed population of CD4- and CD8-positive T cells. Most cases occur as solitary nodules and reoccur in up to 15% of surgically excised cases. 

BALT in normal man is sparse, but a striking reactive lymphoid proliferation can occur in disease. These hyperplastic changes can differ in extent and location within the lung. This is the case in reactive lesions such as follicular bronchiolitis, lymphocytic interstitial pneumonia (LIP), and nodular lymphoid hyperplasia (NLH). 

Table 2 Differential Diagnosis of Nodular Lymphoid Hyperplasia (NLH), Lymphocytic Interstitial Pneumonia (LIP), Follicular Bronchiolitis (FB), and Extranodal Marginal Zone Lymphoma (Maltoma)... 

Figure 3 See color insert.) Nodular lymphoid hyperplasia. The low magnification view shows a lymphoid mass with many folhcle centers obliterating the underlying lung parenchyma.

Moran TJ, Totten RS. Lymphoid interstitial pneumonia with dysproteinemia. Report of two cases with plasma cell predominance. Am J Clin Pathol 1970 54(5) 747-756. Kohler PF, Cook RD, Brown WR, et al. Common variable hypogammaglohuUnemia with T-ceU nodular lymphoid interstitial pneumonitis and B-ceU nodular lymphoid hyperplasia different lymphoc3de populations with a similar response to prednisone therapy. J AUergy Chn Immunol 1982 70(4) 299-305. 

Kawahara K, Shiraishi T, Okabayashi K, et al. Nodular lymphoid hyperplasia in the lung. Thorac Cardiovasc Surg 1996 44 210 12. 

Kajiwara S, Sakia S, Soeda H, et al. Multifocal nodular lymphoid hyperplasia of the lung. J Thorac Imaging 2005 20 239 241. 

Fig. 2.25a,b. Bulboduodenitis. Double contrast barium study (a) demonstrates hypernodularity of the duodenal fold pattern in akidney transplant patient similar appearances may be seen with nodular lymphoid hyperplasia. Endoscopy (b) confirms the findings... 

Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children. Lancet 1998 351 637-A1. 

Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998 351 (9103) 637 U. 

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