Follicular bronchiolitis and lymphocytic interstitial pneumonia in a Japanese man.docVIP

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Follicular bronchiolitis and lymphocytic interstitial pneumonia in a Japanese man.doc

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Follicular bronchiolitis and lymphocytic interstitial pneumonia in a Japanese man

TeradaDiagnosticPathology2011,6:85 /content/6/1/85 CASE REPORT OpenAccess Follicularbronchiolitisandlymphocytic interstitialpneumoniainaJapaneseman TadashiTerada Abstract A44-year-oldJapanesemanconsultedtoourhospitalbecauseofcoughandsputum.Chest-XPandCTrevealed diffusereticularopacitiesinbothlungs. Atransbronchiallungbiopsy(TBLB)showedamoderateinfiltrationoflymphocytesinthealveolarseptae.Hewas diagnosedasinterstitialpneumonia,andtreatedbydrugs.Oneyearlater,hisconditiondeteriolated,andalarge openbiopsywasperformed.Itshowedadiffusesevereinfiltrationoflymphocytesinthealveolarwallsandafew epithelioidgranulomas.Nobronchiolitiswasseen. Immunohistochemicalstudydeniedlymphocytemonoclonality,andhewasdiagnosedaslymphocyticinterstitial pneumonia(LIP).Hewastreatedbysteroid. Sixmonthslater,TBLBshowedperibronchiallymphocyteinfiltration.Alargeopenbiopsyalsorevealedasevere lymphocyticinfiltrationaroundthebronchioles,sparingalveolarwalllymphocyticinfiltration.Immunohistochemical studydeniedmalignantlymphoma.Hewasdiagnosedasfollicularbronchiolitis(FB).Oneyearlater,TBLBshowed littlelymphocyticinfiltrationinthealveolarwallsaswellasperibronchialwalls.Twoyearslater,hiscondition becameworse,andTBLBshowedfeaturesofLIP.Later,hisconditionwasstationaryfor6yearswithmildlung opacitiesfor6years.ThesefindingsshowthatLIPandFBareinterchangeableandoverlapping,andsuggestthat LIPandFBbelongtothesamespectrumofbenignlymphoproliferativedisordersofthelungs. Keywords:lung,follicularbronchitis,lymphocyticinterstitialpneumonia,histopathology,immunohistochemistry Introduction Casereport Follicularbronchiolitis(FB)isabenignlymphoprolifera- A 44-year-old Japanese man consulted to our hospital tivelungdiseasecharacterized byhyperplastic mucosa- because of cough and sputum. Chest-XP and CT associatedlymphoidtissuepresentaroundtheperibron- revealeddiffusereticularopacitiesinbothlungs(Figure chial spaces [1]. Patients with FBare often associated 1).Hehadnootherdiseasesincludingcollagenvascular withcol