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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Lymphomatoid granulomatosis differential diagnosis

Introduction

Overview

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

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)
  • Abnormal LFT‘s
References

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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