nodular lymphoid hyperplasia

A bone marrow finding variously defined as:
(1) The presence of ≥ 4 normal lymphoid aggregates (average size 0.3 mm) in any low-power (40x) light microscopic field; or
(2) An enlarged (> 0.6 mm) lymphoid nodule.

Nodular lymphoid hyperplasia occurs in up to 60% of bone marrow specimens, at autopsy and, when extreme, mimics a lymphoproliferative process.

Associations
ITP, rheumatoid arthritis, cirrhosis, hyperthyroidism, anaemia (autoimmune, haemolytic, drug-related, iron deficiency, and refractory), macroglobulinaemia, Hodgkin lymphoma, large-cell lymphoma, and cryoglobulinaemia.

DiffDx
CLL, primary small-cell lymphoma, well-differentiated lymphoma.

nodular lymphoid hyperplasia (small intestine)

The presence in younger (< age 30) adults of multiple submucosal lymphoid aggregates with prominent germinal centres, most common in the small intestine, but which also occurs in the stomach and the large intestine. In children, NLH may be nonspecific; in adults it is usually pathological and associated with defects in humoral immunity—e.g., selective IgA deficiency, common variable immune deficiency/ hypogammagolulineamia, HIV infection. It may occur in absence of humoral immune defects in patients with giardiasis.

Clinical findings
Range from mild GI discomfort (in IgA deficiency) to severe malabsorption, chronic diarrhoea, recurrent bacterial infections with sinusitis, bronchitis, bronchiectasis, pneumonia (in CVID). Recurrent infections seen in NLH Campylobacoccidiangardiasis, cryptosporidiosis.

Mentioned in

References in periodicals archive

Home hyperalimentation for common variable hypogammaglobulinemia with malabsorption secondary to intestinal nodular lymphoid hyperplasia. Am J Gastroenterol 1987; 82: 1091-5.

Hypogammaglobulinemic sprue manifested as chronic intestinal failure: An uncommon but effective indication for home parenteral nutrition

(1) Nodular shadows have been excluded from the LIP pattern, many of which are now considered diffuse lymphoid hyperplasia or nodular lymphoid hyperplasia. Immunoglobulin G4 (IgG4)-related disease and lymphoproliferative disorders, such as multicentric Castleman disease, are also excluded from the LIP pattern, and many cases previously considered as LIP are now considered cellular nonspecific interstitial pneumonia (NSIP).

Update on Rare Idiopathic Interstitial Pneumonias and Rare Histologic Patterns

Agammaglobulinemia involves gastrointestinal tract like chronic-atrophic gastritis, giardiasis, sprue-like disorder with atrophied villi, inflammatory bowel disease, nonspecific intestinal malabsorption, nodular lymphoid hyperplasia, and pernicious anaemia [8, 9].

Inflammatory Duodenal Polyposis Associated with Primary Immunodeficiency Disease: A Novel Case Report

The significant findings included ulcers and erosions in 36%, erythema in 22%, aphthae in 17%, nodular lymphoid hyperplasia in 20%, and other features in 5%.

Capsule endoscopy and Crohn's

* Nodular lymphoid hyperplasia. Other small polyps formed by a normal intestinal lymphoid response to infectious, chemical, or traumatic insult can become friable and ulcerate, with some bleeding.

Four benign disorders behind most rectal bleeding. (Seemingly Healthy Infants and Children)

Nodular lymphoid hyperplasia is easily distinguished from follicular bronchiolitis by its radiographic and histologic features.

Unlike either follicular bronchiolitis or nodular lymphoid hyperplasia, low-grade B-cell lymphoma of BALT is characterized by fairly monomorphous infiltrate of B lymphocytes.

Update on nonneoplastic pulmonary lymphoproliferative disorders and related entities

Familial pulmonary nodular lymphoid hyperplasia. J Pediatr.

Pseudoneoplastic lesions: general considerations

Pulmonary nodular lymphoid hyperplasia (NLH), a term first coined by Kradin and Mark, (33) refers to 1 or more nodules or localized pulmonary infiltrates consisting of a reactive lymphoid proliferation.

Pulmonary pseudoneoplasms

It has been described in a number of conditions including human immunodeficiency virus infection, Crohn disease, and hypogammaglobulinemia.[4] In this case, the distribution of the melanosis pigment as shown in the endoscopic photograph (Figure 1) emphasizes the diffuse nature of the patient's diffuse nodular lymphoid hyperplasia of the colon and rectum.

Colonic Lymphoid Hyperplasia in Melanosis Coli