Lymphomatoid granulomatosis differential diagnosis: Difference between revisions

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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Lymphmatoid  granulomatosis<ref name="pmid23006954">{{cite journal| author=Roschewski M, Wilson WH| title=Lymphomatoid granulomatosis. | journal=Cancer J | year= 2012 | volume= 18 | issue= 5 | pages= 469-74 | pmid=23006954 | doi=10.1097/PPO.0b013e31826c5e19 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23006954  }} </ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lymphmatoid  granulomatosis]]<ref name="pmid23006954">{{cite journal| author=Roschewski M, Wilson WH| title=Lymphomatoid granulomatosis. | journal=Cancer J | year= 2012 | volume= 18 | issue= 5 | pages= 469-74 | pmid=23006954 | doi=10.1097/PPO.0b013e31826c5e19 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23006954  }} </ref>
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| style="background: #F5F5F5; padding: 5px;" |[[Mononucleosis|EBV i]]<nowiki/>nfused [[B cell|B-cells]] on blood scan  
| style="background: #F5F5F5; padding: 5px;" |[[Mononucleosis|EBV i]]<nowiki/>nfused [[B cell|B-cells]] on blood scan  
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* Dense, large, mass like infiltrate and bilateral nodular disease.
* Dense, large, mass like infiltrate and bilateral [[Nodular lesions|nodular]] disease.
| style="background: #F5F5F5; padding: 5px;" |Poorly defined nodular peribronchovascular infiltrates with air-bronchograms.
| style="background: #F5F5F5; padding: 5px;" |Poorly defined nodular peribronchovascular infiltrates with air-bronchograms.
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** Nodular and diffuse lymphoid infiltrates  
** Nodular and diffuse [[Lymphocyte|lymphoid]] infiltrates  
** Centers of nodules have large vessels  
** Centers of [[Nodule (medicine)|nodules]] have large vessels  
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** Predisposing factor immunodeficient states
** Predisposing factor immunodeficient states
** Patients may have fever of unknown origin, hemoptysis, history of multiple skin or other biopsies without diagnosis
** Patients may have [[fever of unknown origin]], [[hemoptysis]], history of multiple skin or other [[Biopsy|biopsies]] without diagnosis
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Churg-Strauss syndrome<ref name="Della Rossa2002">{{cite journal|last1=Della Rossa|first1=A.|title=Churg-Strauss syndrome: clinical and serological features of 19 patients from a single Italian centre|journal=Rheumatology|volume=41|issue=11|year=2002|pages=1286–1294|issn=14602172|doi=10.1093/rheumatology/41.11.1286}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Eosinophilic granulomatosis with polyangiitis|Churg-Strauss syndrome]]<ref name="Della Rossa2002">{{cite journal|last1=Della Rossa|first1=A.|title=Churg-Strauss syndrome: clinical and serological features of 19 patients from a single Italian centre|journal=Rheumatology|volume=41|issue=11|year=2002|pages=1286–1294|issn=14602172|doi=10.1093/rheumatology/41.11.1286}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |Wheezing
| style="background: #F5F5F5; padding: 5px;" |[[Wheeze|Wheezing]]


Rales
[[Rales]]


Rhonchi
[[Rhonchi]]
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* Greater than 50% have positive ANCA, often antimyeloperoxidase
* Greater than 50% have positive [[Anti-neutrophil cytoplasmic antibody|ANCA]], often antimyeloperoxidase
* Eosinophilia
* [[Eosinophilia]]
* Elevated ESR
* Elevated [[Erythrocyte sedimentation rate|ESR]]
| style="background: #F5F5F5; padding: 5px;" |Pulmonary infiltrates:   
| style="background: #F5F5F5; padding: 5px;" |Pulmonary infiltrates:   
Typically, these are transient patchy alveolar infiltrates.
Typically, these are transient patchy alveolar infiltrates.
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* Subpleural airspace consolidation
* Subpleural airspace consolidation
* Enlarged hilar or mediastinal lymph nodes  
* Enlarged [[Hilar lymphadenopathy|hilar]] or mediastinal lymph nodes  
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* Lung and extrapulmonary sites with eosinophilic infiltrate,  
* Lung and extrapulmonary sites with [[eosinophilic]] infiltrate,  
* Granulomatous reaction  
* [[Granuloma|Granulomatous]] reaction  
* May have edema, lymphocytes, sarcoid-like granulomas.
* May have edema, lymphocytes, sarcoid-like granulomas.
| style="background: #F5F5F5; padding: 5px;" | + P-ANCA in cells on lung biposy
| style="background: #F5F5F5; padding: 5px;" | + [[Anti-neutrophil cytoplasmic antibody|P-ANCA]] in cells on lung biposy
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* Very rare
* Very rare
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Necrotizing sarcoid granulomatosis<ref name="Quaden2005">{{cite journal|last1=Quaden|first1=C.|title=Necrotising sarcoid granulomatosis: clinical, functional, endoscopical and radiographical evaluations|journal=European Respiratory Journal|volume=26|issue=5|year=2005|pages=778–785|issn=0903-1936|doi=10.1183/09031936.05.00024205}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoidosis|Necrotizing sarcoid granulomatosis]]<ref name="Quaden2005">{{cite journal|last1=Quaden|first1=C.|title=Necrotising sarcoid granulomatosis: clinical, functional, endoscopical and radiographical evaluations|journal=European Respiratory Journal|volume=26|issue=5|year=2005|pages=778–785|issn=0903-1936|doi=10.1183/09031936.05.00024205}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |Wheezing
| style="background: #F5F5F5; padding: 5px;" |[[Wheeze|Wheezing]]
| style="background: #F5F5F5; padding: 5px;" |Increased levels of ACE in the blood  
| style="background: #F5F5F5; padding: 5px;" |Increased levels of [[Angiotensin-converting enzyme|ACE]] in the blood  
| style="background: #F5F5F5; padding: 5px;" |Hilar adenopathy
| style="background: #F5F5F5; padding: 5px;" |[[Hilar lymphadenopathy|Hilar]] adenopathy
| style="background: #F5F5F5; padding: 5px;" |bihilar lymphadenopathy and reticulonodular infiltrates
| style="background: #F5F5F5; padding: 5px;" |[[bihilar lymphadenopathy]] and [[reticulonodular]] infiltrates
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* Inflammatory and granulomatous reactions
* Inflammatory and [[granulomatous]] reactions
* Resembling lymphoma  and atypia
* Resembling [[lymphoma]] and [[atypia]]
* Dense, noncaseating granulomas  
* Dense, noncaseating [[Granuloma|granulomas]]
* Also Schaumann bodies  
* Also [[Schaumann bodies]]
| style="background: #F5F5F5; padding: 5px;" |High levels of ACE in blood
| style="background: #F5F5F5; padding: 5px;" |High levels of [[Angiotensin-converting enzyme|ACE]] in blood
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* Affects skin, lymph nodes and organs
* Affects skin, lymph nodes and organs
* Diagnosis of exclusion
* Diagnosis of exclusion
* Patients often have anergy to delayed hypersensitivity tests
* Patients often have anergy to delayed [[hypersensitivity]] tests
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!Diseases
!Diseases
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!Additional findings
!Additional findings
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Wegeners granulomatosis<ref name="de GrootGross2016">{{cite journal|last1=de Groot|first1=K|last2=Gross|first2=W L|title=Wegener's granulomatosis: disease course, assessment of activity and                extent and treatment|journal=Lupus|volume=7|issue=4|year=2016|pages=285–291|issn=0961-2033|doi=10.1191/096120398678920118}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wegeners granulomatosis history and symptoms|Wegeners granulomatosis]]<ref name="de GrootGross2016">{{cite journal|last1=de Groot|first1=K|last2=Gross|first2=W L|title=Wegener's granulomatosis: disease course, assessment of activity and                extent and treatment|journal=Lupus|volume=7|issue=4|year=2016|pages=285–291|issn=0961-2033|doi=10.1191/096120398678920118}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |Wheezing
| style="background: #F5F5F5; padding: 5px;" |[[Wheeze|Wheezing]]
| style="background: #F5F5F5; padding: 5px;" |C- ANCA
| style="background: #F5F5F5; padding: 5px;" |[[Anti-neutrophil cytoplasmic antibody|C- ANCA]]


Urinalysis:
[[Urinalysis]]:


Hematuria  
[[Hematuria]]


Red cell casts
[[Red cell casts]]


Biopsy: Granulomatous inflmmation within the arterial wall ''or'' in the perivascular area
Biopsy: [[Granulomatous]] inflmmation within the arterial wall ''or'' in the perivascular area
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* Nodules,
* [[Nodule (medicine)|Nodules]],
* Infiltrates ''or''
* [[Infiltrates]] ''or''
* Cavities
* [[Cavity|Cavities]]
| style="background: #F5F5F5; padding: 5px;" |Pulmonary nodules with or without cavitation and airspace consolidation
| style="background: #F5F5F5; padding: 5px;" |Pulmonary [[Nodule (medicine)|nodules]] with or without cavitation and airspace consolidation
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** Liquefactive or coagulative necrosis in lungs  
** [[Liquefactive necrosis|Liquefactive]] or [[coagulative necrosis]] in lungs  
** Destructive leukocytic angiitis of arteries and veins  
** Destructive leukocytic [[angiitis]] of arteries and veins  
| style="background: #F5F5F5; padding: 5px;" |Biopsy of the lung
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] of the lung
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* p-ANCA: perinuclear staining, directed against myeloperoxidase, is usually negative,
* [[p-ANCA]]: perinuclear staining, directed against [[myeloperoxidase]], is usually negative,
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hodgkin disease<ref name="TownsendLinch2012">{{cite journal|last1=Townsend|first1=William|last2=Linch|first2=David|title=Hodgkin's lymphoma in adults|journal=The Lancet|volume=380|issue=9844|year=2012|pages=836–847|issn=01406736|doi=10.1016/S0140-6736(12)60035-X}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hodgkin's lymphoma|Hodgkin disease]]<ref name="TownsendLinch2012">{{cite journal|last1=Townsend|first1=William|last2=Linch|first2=David|title=Hodgkin's lymphoma in adults|journal=The Lancet|volume=380|issue=9844|year=2012|pages=836–847|issn=01406736|doi=10.1016/S0140-6736(12)60035-X}}</ref>
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* Contains a small number of the characteristic neoplastic cells ('''Hodgkin and Reed-Sternberg cells''' or '''lymphocyte predominant cells''') within a background rich in inflammatory cells
* Contains a small number of the characteristic [[neoplastic]] cells ('''Hodgkin and [[Reed-Sternberg cell|Reed-Sternberg cells]]''' or '''[[lymphocyte]] predominant cells''') within a background rich in inflammatory cells
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* Parenchymal lung involvement occurs in 1/3 of patients with Hodgkin
* [[Parenchyma|Parenchymal]] lung involvement occurs in 1/3 of patients with Hodgkin
* Almost all have associated hilar or mediastinal adenopathy
* Almost all have associated hilar or mediastinal adenopathy
| style="background: #F5F5F5; padding: 5px;" |Massive mediastinal soft tissue masses consistent with lymphoma
| style="background: #F5F5F5; padding: 5px;" |Massive [[mediastinal]] soft tissue masses consistent with [[lymphoma]]
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* Neoplastic cells are Hodgkin and Reed-Sternberg (HRS) cells
* [[Neoplastic]] cells are [[Hodgkin's lymphoma|Hodgkin]] and [[Reed-Sternberg cell|Reed-Sternberg]] (HRS) cells
* Effaced lymph node with variable number of HRS cells  
* Effaced [[lymph node]] with variable number of [[Reed-Sternberg cell|HRS]] cells  
| style="background: #F5F5F5; padding: 5px;" |Reed Sternberg cells
| style="background: #F5F5F5; padding: 5px;" |[[Reed-Sternberg cell|Reed-sternberg cells]]
| style="background: #F5F5F5; padding: 5px;" |Development of Hodgkin's disease may in some patients be preceded by enhanced activation of Epstein–Barr virus
| style="background: #F5F5F5; padding: 5px;" |Development of [[Hodgkin's lymphoma|Hodgkin's disease]] may in some patients be preceded by enhanced activation of [[Epstein Barr virus|Epstein–Barr virus]]
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Non-hodgkin lymphoma<ref name="ZelenetzAbramson2011">{{cite journal|last1=Zelenetz|first1=Andrew D.|last2=Abramson|first2=Jeremy S.|last3=Advani|first3=Ranjana H.|last4=Andreadis|first4=C. Babis|last5=Bartlett|first5=Nancy|last6=Bellam|first6=Naresh|last7=Byrd|first7=John C.|last8=Czuczman|first8=Myron S.|last9=Fayad|first9=Luis E.|last10=Glenn|first10=Martha J.|last11=Gockerman|first11=Jon P.|last12=Gordon|first12=Leo I.|last13=Harris|first13=Nancy Lee|last14=Hoppe|first14=Richard T.|last15=Horwitz|first15=Steven M.|last16=Kelsey|first16=Christopher R.|last17=Kim|first17=Youn H.|last18=LaCasce|first18=Ann S.|last19=Nademanee|first19=Auayporn|last20=Porcu|first20=Pierluigi|last21=Press|first21=Oliver|last22=Pro|first22=Barbara|last23=Reddy|first23=Nashitha|last24=Sokol|first24=Lubomir|last25=Swinnen|first25=Lode J.|last26=Tsien|first26=Christina|last27=Vose|first27=Julie M.|last28=Wierda|first28=William G.|last29=Yahalom|first29=Joachim|last30=Zafar|first30=Nadeem|title=Non-Hodgkin's Lymphomas|journal=Journal of the National Comprehensive Cancer Network|volume=9|issue=5|year=2011|pages=484–560|issn=1540-1405|doi=10.6004/jnccn.2011.0046}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Non-Hodgkin lymphoma|Non-hodgkin lymphoma]]<ref name="ZelenetzAbramson2011">{{cite journal|last1=Zelenetz|first1=Andrew D.|last2=Abramson|first2=Jeremy S.|last3=Advani|first3=Ranjana H.|last4=Andreadis|first4=C. Babis|last5=Bartlett|first5=Nancy|last6=Bellam|first6=Naresh|last7=Byrd|first7=John C.|last8=Czuczman|first8=Myron S.|last9=Fayad|first9=Luis E.|last10=Glenn|first10=Martha J.|last11=Gockerman|first11=Jon P.|last12=Gordon|first12=Leo I.|last13=Harris|first13=Nancy Lee|last14=Hoppe|first14=Richard T.|last15=Horwitz|first15=Steven M.|last16=Kelsey|first16=Christopher R.|last17=Kim|first17=Youn H.|last18=LaCasce|first18=Ann S.|last19=Nademanee|first19=Auayporn|last20=Porcu|first20=Pierluigi|last21=Press|first21=Oliver|last22=Pro|first22=Barbara|last23=Reddy|first23=Nashitha|last24=Sokol|first24=Lubomir|last25=Swinnen|first25=Lode J.|last26=Tsien|first26=Christina|last27=Vose|first27=Julie M.|last28=Wierda|first28=William G.|last29=Yahalom|first29=Joachim|last30=Zafar|first30=Nadeem|title=Non-Hodgkin's Lymphomas|journal=Journal of the National Comprehensive Cancer Network|volume=9|issue=5|year=2011|pages=484–560|issn=1540-1405|doi=10.6004/jnccn.2011.0046}}</ref>
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| style="background: #F5F5F5; padding: 5px;" |Can be caused by;
| style="background: #F5F5F5; padding: 5px;" |Can be caused by;
EBV  
[[Epstein Barr virus|EBV]]


HIV  
[[Human Immunodeficiency Virus (HIV)|HIV]]


Hep BandC
[[Hepatitis B|Hep B]]<nowiki/>and[[Hepatitis C|C]]


HTLV
[[Human T-lymphotropic virus|HTLV]]


Lymphomatous appearing B and T cells( condition arises from B and T cells)
Lymphomatous appearing [[B cell|B]] and [[T cell|T cells]]( condition arises from B and T cells)


Abnormal LFT's
Abnormal [[Liver function tests|LFT]]'s


CBC count: Can be normal in early-stage disease; in more advanced stages, can show anemia, thrombocytopenia/leukopenia/pancytopenia, lymphocytosis, thrombocytosis
CBC count: Can be normal in early-stage disease; in more advanced stages, can show [[anemia]], [[thrombocytopenia]]/[[leukopenia]]/[[pancytopenia]], [[lymphocytosis]], [[thrombocytosis]]
| style="background: #F5F5F5; padding: 5px;" |Mediastinal widening  
| style="background: #F5F5F5; padding: 5px;" |[[Widened mediastinum|Mediastinal widening]]
| style="background: #F5F5F5; padding: 5px;" |Mediastinum can show enlarged tracheobronchial and subcarinal nodes. small bilateral pleural effusion can be seen
| style="background: #F5F5F5; padding: 5px;" |[[Mediastinum]] can show enlarged [[tracheobronchial]] and subcarinal nodes. small bilateral [[pleural effusion]] can be seen
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* Sensitivity and specificity of diagnosis with fine needle aspiration increases with use of flow cytometry
* Sensitivity and specificity of diagnosis with fine [[Needle aspiration biopsy|needle aspiration]] increases with use of flow cytometry
* occasionally associated with monoclonal gammopathy;
* occasionally associated with [[monoclonal gammopathy]];
| style="background: #F5F5F5; padding: 5px;" |Pop corn cells in NLPHL
| style="background: #F5F5F5; padding: 5px;" |Pop corn cells in [[Nodular lymphocyte predominant Hodgkin lymphoma|NLPHL]]
| style="background: #F5F5F5; padding: 5px;" |Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredness
| style="background: #F5F5F5; padding: 5px;" |Symptoms include [[enlarged lymph nodes]], [[fever]], [[Sleep hyperhidrosis|night sweats]], [[weight loss]], and [[Fatigue|tiredness]]
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Revision as of 19:09, 6 December 2018

Lymphomatoid granulomatosis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Lymphamtoid granulomatosis must be differentiated from Bronchocentric granulomatosis and Churg-Strauss, Necrotizing sarcoid granulomatosis, Wegeners granulomatosis, Hodgkins disease, Non-hodgkin lymphoma, and Nasal angiocentric lymphoma

Differentiating Lymphamatoid granulomatosis from other Diseases

As Lymphamatoid granulomatosis manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtypes pulmonary being the most common. The sub types are the following:[1][2][3][4][5][6]

Other Symptoms that are asscociated with the pulmonary symptoms are:[10][11][12]

From the symptoms listed above; Lymphamatoid granulomatosis is usually differtiated from the following diseases Bronchocentric granulomatosis and Churg-Strauss, Necrotizing sarcoid granulomatosis, Wegeners granulomatosis, Hodgkins disease, Non-hodgkin lymphoma, and Nasal angiocentric lymphoma.[15][16][17]

In contrast, CNS lymphamatoid granulomatosis must be differentiated from other diseases that cause:[18][19][20][21]

The differentials are the following CVA, Brain tumors or CNS lymphoma and Parkinsonism.[26]

Finally Cutaneous Lymphamatoid granulomatosis must also be differtiated from other diseases that cause:[21][27][28]

The differentials are the following Dermatomyositis, and Psoriasis[34][10]

Differentiating Lymphamatoid Granulomatosis

On the basis of Cough, Dyspnea, and Chest tightness, Lymphamatoid granulomatosis must be differentiated from Bronchocentric granulomatosis and Churg-Strauss, Necrotizing sarcoid granulomatosis, Wegeners granulomatosis, Hodgkins disease, Non-hodgkin lymphoma, and Nasal angiocentric lymphoma.[15][16][17]

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Cough Dyspnea Chest tightness Auscultation X-ray CT scan
Lymphmatoid granulomatosis[1] + + + Wheezing

Rales

Rhonchi

EBV infused B-cells on blood scan
  • Dense, large, mass like infiltrate and bilateral nodular disease.
Poorly defined nodular peribronchovascular infiltrates with air-bronchograms.
    • Nodular and diffuse lymphoid infiltrates
    • Centers of nodules have large vessels
Churg-Strauss syndrome[35] + + + Wheezing

Rales

Rhonchi

Pulmonary infiltrates:

Typically, these are transient patchy alveolar infiltrates.

  • Subpleural airspace consolidation
  • Enlarged hilar or mediastinal lymph nodes
  • Lung and extrapulmonary sites with eosinophilic infiltrate,
  • Granulomatous reaction
  • May have edema, lymphocytes, sarcoid-like granulomas.
+ P-ANCA in cells on lung biposy
  • Very rare
Necrotizing sarcoid granulomatosis[36] + + - Wheezing Increased levels of ACE in the blood Hilar adenopathy bihilar lymphadenopathy and reticulonodular infiltrates High levels of ACE in blood
  • Affects skin, lymph nodes and organs
  • Diagnosis of exclusion
  • Patients often have anergy to delayed hypersensitivity tests
Diseases Cough Dyspnea Chest thightness Auscultation Lab findings X-ray CT scan Histopathology Gold standard Additional findings
Wegeners granulomatosis[37] + + - Wheezing C- ANCA

Urinalysis:

Hematuria

Red cell casts

Biopsy: Granulomatous inflmmation within the arterial wall or in the perivascular area

Pulmonary nodules with or without cavitation and airspace consolidation Biopsy of the lung
Hodgkin disease[38] - - -
  • Parenchymal lung involvement occurs in 1/3 of patients with Hodgkin
  • Almost all have associated hilar or mediastinal adenopathy
Massive mediastinal soft tissue masses consistent with lymphoma Reed-sternberg cells Development of Hodgkin's disease may in some patients be preceded by enhanced activation of Epstein–Barr virus
Non-hodgkin lymphoma[39] - - - Can be caused by;

EBV

HIV

Hep BandC

HTLV

Lymphomatous appearing B and T cells( condition arises from B and T cells)

Abnormal LFT's

CBC count: Can be normal in early-stage disease; in more advanced stages, can show anemia, thrombocytopenia/leukopenia/pancytopenia, lymphocytosis, thrombocytosis

Mediastinal widening Mediastinum can show enlarged tracheobronchial and subcarinal nodes. small bilateral pleural effusion can be seen Pop corn cells in NLPHL Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredness

References

  1. 1.0 1.1 Roschewski M, Wilson WH (2012). "Lymphomatoid granulomatosis". Cancer J. 18 (5): 469–74. doi:10.1097/PPO.0b013e31826c5e19. PMID 23006954.
  2. Fernandez-Alvarez R, Gonzalez M, Fernandez A, Gonzalez-Rodriguez A, Sancho J, Dominguez F; et al. (2014). "Lymphomatoid granulomatosis of central nervous system and lung driven by epstein barr virus proliferation: successful treatment with rituximab-containing chemotherapy". Mediterr J Hematol Infect Dis. 6 (1): e2014017. doi:10.4084/MJHID.2014.017. PMC 3965717. PMID 24678394.
  3. 3.0 3.1 3.2 3.3 3.4 {{cite journal| author=Shaigany S, Weitz NA, Husain S, Geskin L, Grossman ME| title=A case of lymphomatoid granulomatosis presenting with cutaneous lesions. | journal=JAAD Case Rep | year= 2015 | volume= 1 | issue= 4 | pages= 234-7 | pmid=27051739 | doi=10.1016/j.jdcr.2015.05.008 | pmc=4808726 | url=
    • Pulmonary
    • CNS
    • Cutaneous
    Pulmonary Lymphamatoid granulomatosis must be differentiated from other diseases that cause:<ref name="pmid26078192">Santalla-Martínez M, García-Quiroga H, Navarro-Menéndez I (2015). "Pulmonary lymphomatoid granulomatosis. A rare entity in the differential diagnosis of pulmonary nodules". Arch Bronconeumol. 51 (11): 606–7. doi:10.1016/j.arbres.2015.05.003. PMID 26078192.
  4. Miloslavsky EM, Stone JH, Unizony SH (2015). "Challenging mimickers of primary systemic vasculitis". Rheum Dis Clin North Am. 41 (1): 141–60, ix. doi:10.1016/j.rdc.2014.09.011. PMID 25399945.
  5. Tagliavini E, Rossi G, Valli R, Zanelli M, Cadioli A, Mengoli MC; et al. (2013). "Lymphomatoid granulomatosis: a practical review for pathologists dealing with this rare pulmonary lymphoproliferative process". Pathologica. 105 (4): 111–6. PMID 24466760.
  6. Fauci AS, Haynes BF, Costa J, Katz P, Wolff SM (1982). "Lymphomatoid Granulomatosis. Prospective clinical and therapeutic experience over 10 years". N Engl J Med. 306 (2): 68–74. doi:10.1056/NEJM198201143060203. PMID 7053488.
  7. Xu B, Liu H, Wang B, Zhang H, Wu H, Jin R; et al. (2015). "Fever, Dry Cough and Exertional Dyspnea: Pulmonary Lymphomatoid Granulomatosis Masquerading as Pneumonia, Granulomatosis with Polyangiitis and Infectious Mononucleosis". Intern Med. 54 (23): 3045–9. doi:10.2169/internalmedicine.54.4822. PMID 26631890.
  8. Ameli F, Ghafourian F, Masir N (2014). "Systematic Epstein-Barr virus-positive T-cell lymphoproliferative disease presenting as a persistent fever and cough: a case report". J Med Case Rep. 8: 288. doi:10.1186/1752-1947-8-288. PMC 4150421. PMID 25163591.
  9. Olusina D, Ezemba N, Nzegwu MA (2011). "Pulmonary Lymphomatoid Granulomatosis: Report of A Case and Review of Literature". Niger Med J. 52 (1): 60–63. PMC 3180752. PMID 21968985.
  10. 10.0 10.1 10.2 10.3 O'Brien S, Schmidt P (2016). "Lymphomatoid Granulomatosis with Paraneoplastic Polymyositis: A Rare Malignancy with Rare Complication". Case Rep Rheumatol. 2016: 8242597. doi:10.1155/2016/8242597. PMC 4757691. PMID 26966605.
  11. Alinari L, Pant S, McNamara K, Kalmar JR, Marsh W, Allen CM; et al. (2012). "Lymphomatoid granulomatosis presenting with gingival involvement in an immune competent elderly male". Head Neck Pathol. 6 (4): 496–501. doi:10.1007/s12105-012-0378-z. PMC 3500898. PMID 22711054.
  12. Alexandra G, Claudia G (2018). "Lymphomatoid granulomatosis mimicking cancer and sarcoidosis". Ann Hematol. doi:10.1007/s00277-018-3505-4. PMID 30288554.
  13. Olmes DG, Agaimy A, Kloska S, Linker RA (2014). "Fatal lymphomatoid granulomatosis with primary CNS-involvement in an immunocompetent 80-year-old woman". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-206825. PMC 4275695. PMID 25535225.
  14. Costiniuk, Cecilia T.; Karamchandani, Jason; Bessissow, Ali; Routy, Jean-Pierre; Szabo, Jason; Frenette, Charles (2018). "Angiocentric lymph proliferative disorder (lymphomatoid granulomatosis) in a person with newly-diagnosed HIV infection: a case report". BMC Infectious Diseases. 18 (1). doi:10.1186/s12879-018-3128-3. ISSN 1471-2334.
  15. 15.0 15.1 Bohle M, Rasche K, Müller KM, Schultze-Werninghaus G, Fisseler-Eckhoff A (1999). "[Lymphomatoid granulomatosis: differential diagnosis and therapy]". Med Klin (Munich). 94 (9): 513–9. PMID 10544614.
  16. 16.0 16.1 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMC 5922622. PMID doi.org/10.1053/stcs.2002.34450 Check |pmid= value (help).
  17. 17.0 17.1 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMC 5922622. PMID https://doi.org/10.1007/s00247-014-3233-4 Check |pmid= value (help).
  18. Kim JY, Jung KC, Park SH, Choe JY, Kim JE (2018). "Primary lymphomatoid granulomatosis in the central nervous system: A report of three cases". Neuropathology. doi:10.1111/neup.12467. PMID 29635846.
  19. Kano Y, Kodaira M, Ushiki A, Kosaka M, Yamada M, Shingu K; et al. (2017). "The Complete Remission of Acquired Immunodeficiency Syndrome-associated Isolated Central Nervous System Lymphomatoid Granulomatosis: A Case Report and Review of the Literature". Intern Med. 56 (18): 2497–2501. doi:10.2169/internalmedicine.8776-16. PMC 5643181. PMID 28824078.
  20. Quinones E, Potes LI, Silva N, Lobato-Polo J (2016). "Lymphomatoid granulomatosis of the brain: A case report". Surg Neurol Int. 7 (Suppl 23): S612–6. doi:10.4103/2152-7806.189732. PMC 5025951. PMID 27656321.
  21. 21.0 21.1 Halvani A, Owlia MB, Sami R (2010). "Lymphomatoid granulomatosis with splenomegaly and pancytopenia". Zhongguo Fei Ai Za Zhi. 13 (1): 84–6. doi:10.3779/j.issn.1009-3419.2010.01.17. PMC 6000673. PMID 20672711.
  22. Castrale C, El Haggan W, Chapon F, Reman O, Lobbedez T, Ryckelynck JP; et al. (2011). "Lymphomatoid granulomatosis treated successfully with rituximab in a renal transplant patient". J Transplant. 2011: 865957. doi:10.1155/2011/865957. PMC 3087939. PMID 21559262.
  23. Liu, Hongli; Chen, Jing; Yu, Dandan; Hu, Jianli (2014). "Lymphomatoid granulomatosis involving the central nervous system: A case report and review of the literature". Oncology Letters. 7 (6): 1843–1846. doi:10.3892/ol.2014.2002. ISSN 1792-1074.
  24. Patsalides, Athos D.; Atac, Gokce; Hedge, Upendra; Janik, John; Grant, Nicole; Jaffe, Elaine S.; Dwyer, Andrew; Patronas, Nicholas J.; Wilson, Wyndham H. (2005). "Lymphomatoid Granulomatosis: Abnormalities of the Brain at MR Imaging". Radiology. 237 (1): 265–273. doi:10.1148/radiol.2371041087. ISSN 0033-8419.
  25. Cargini, Pasqualino; Civica, Maria; Sollima, Laura; Di Cola, Emanuela; Pontecorvi, Emanuele; Cutilli, Tommaso (2014). "Oral lymphomatoid granulomatosis, the first sign of a 'rare disease': a case report". Journal of Medical Case Reports. 8 (1). doi:10.1186/1752-1947-8-152. ISSN 1752-1947.
  26. Sohn EH, Song CJ, Lee HJ, Kim S, Kim JM, Lee AY (2007). "Central nervous system lymphomatoid granulomatosis presenting with parkinsonism". J Clin Neurol. 3 (2): 108–11. doi:10.3988/jcn.2007.3.2.108. PMC 2686859. PMID 19513302.
  27. Rysgaard CD, Stone MS (2015). "Lymphomatoid granulomatosis presenting with cutaneous involvement: a case report and review of the literature". J Cutan Pathol. 42 (3): 188–93. doi:10.1111/cup.12402. PMID 25355540.
  28. Gangar P, Venkatarajan S (2015). "Granulomatous Lymphoproliferative Disorders: Granulomatous Slack Skin and Lymphomatoid Granulomatosis". Dermatol Clin. 33 (3): 489–96. doi:10.1016/j.det.2015.03.013. PMID 26143428.
  29. Carlson, Keith C. (1991). "Cutaneous Signs of Lymphomatoid Granulomatosis". Archives of Dermatology. 127 (11): 1693. doi:10.1001/archderm.1991.01680100093011. ISSN 0003-987X.
  30. Minars, Norman (1975). "Lymphomatoid Granulomatosis of the Skin". Archives of Dermatology. 111 (4): 493. doi:10.1001/archderm.1975.01630160083009. ISSN 0003-987X.
  31. Rysgaard, Carolyn D.; Stone, Mary Seabury (2015). "Lymphomatoid granulomatosis presenting with cutaneous involvement: a case report and review of the literature". Journal of Cutaneous Pathology. 42 (3): 188–193. doi:10.1111/cup.12402. ISSN 0303-6987.
  32. Prieto Herman Reinehr, Clarissa; Corrêa Martins, Carla; Trein Cunha, Vivian; Elen Lira, Franci; Sprinz, Eduardo; Cartell, André; Bakos, Renato Marchiori (2017). "Cutaneous human immunodeficiency virus (HIV)-associated lymphomatoid granulomatosis: complete regression following antiretroviral therapy". International Journal of Dermatology. 56 (5): e100–e102. doi:10.1111/ijd.13551. ISSN 0011-9059.
  33. Lee, Lynette Y.; Namuduri, Rama; Chan, Michelle M. F.; Quek, Jeffrey K. S.; Koh, Mark J.-A. (2018). "Epstein-Barr virus positive diffuse large B-cell lymphoma presenting with vaginal sloughing and ulcerated skin nodule". Journal of Cutaneous Pathology. 45 (2): 162–166. doi:10.1111/cup.13074. ISSN 0303-6987.
  34. Berti, Alvise; Felicetti, Mara; Peccatori, Susanna; Bortolotti, Roberto; Guella, Anna; Vivaldi, Paolo; Morelli, Luca; Barabareschi, Mattia; Paolazzi, Giuseppe (2018). "EBV-induced lymphoproliferative disorders in rheumatic patients: A systematic review of the literature". Joint Bone Spine. 85 (1): 35–40. doi:10.1016/j.jbspin.2017.01.006. ISSN 1297-319X.
  35. Della Rossa, A. (2002). "Churg-Strauss syndrome: clinical and serological features of 19 patients from a single Italian centre". Rheumatology. 41 (11): 1286–1294. doi:10.1093/rheumatology/41.11.1286. ISSN 1460-2172.
  36. Quaden, C. (2005). "Necrotising sarcoid granulomatosis: clinical, functional, endoscopical and radiographical evaluations". European Respiratory Journal. 26 (5): 778–785. doi:10.1183/09031936.05.00024205. ISSN 0903-1936.
  37. de Groot, K; Gross, W L (2016). "Wegener's granulomatosis: disease course, assessment of activity and extent and treatment". Lupus. 7 (4): 285–291. doi:10.1191/096120398678920118. ISSN 0961-2033.
  38. Townsend, William; Linch, David (2012). "Hodgkin's lymphoma in adults". The Lancet. 380 (9844): 836–847. doi:10.1016/S0140-6736(12)60035-X. ISSN 0140-6736.
  39. Zelenetz, Andrew D.; Abramson, Jeremy S.; Advani, Ranjana H.; Andreadis, C. Babis; Bartlett, Nancy; Bellam, Naresh; Byrd, John C.; Czuczman, Myron S.; Fayad, Luis E.; Glenn, Martha J.; Gockerman, Jon P.; Gordon, Leo I.; Harris, Nancy Lee; Hoppe, Richard T.; Horwitz, Steven M.; Kelsey, Christopher R.; Kim, Youn H.; LaCasce, Ann S.; Nademanee, Auayporn; Porcu, Pierluigi; Press, Oliver; Pro, Barbara; Reddy, Nashitha; Sokol, Lubomir; Swinnen, Lode J.; Tsien, Christina; Vose, Julie M.; Wierda, William G.; Yahalom, Joachim; Zafar, Nadeem (2011). "Non-Hodgkin's Lymphomas". Journal of the National Comprehensive Cancer Network. 9 (5): 484–560. doi:10.6004/jnccn.2011.0046. ISSN 1540-1405.

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