Lymphomatoid granulomatosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kamal Akbar, M.D.[2]

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] + + +
  • 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] + + +
  • 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] + + -
  • Increased levels of ACE in the blood
 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] + + -
  • Pulmonary nodules with or without cavitation
  • airspace consolidation
Hodgkin disease[38] - - -
  • Parenchymal lung involvement occurs in 1/3 of patients with Hodgkin
  • Almost all have associated hilar or mediastinal adenopathy
Non-hodgkin lymphoma[39] - - -
  • Lymphomatous appearing B and T cells( condition arises from B and T cells)

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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