2026年 · 第106卷第08期

The patient, a 73-year-old female, was admitted to the respiratory department of Qingdao Municipal Hospital on October 21, 2024 due to "pulmonary nodules found for 3 weeks". Previously, he underwent "hysterectomy" in December 2021 due to "endometrial malignant tumor". Specialist examination showed clear breathing sounds in both lungs, and no dry or wet rales were heard. The detection of carcinoembryonic antigen, neuron-specific enolase, squamous cell carcinoma antigen and anti-tuberculosis antibody were negative at admission. On October 22, 2024, the results of chest enhancement CT showed a nodular focus near the pleura in the lower lobe of the right lung, with clear boundaries and a size of about 17 mm ×12 mm. The enhancement around the enhancement scan was more obvious than the center, and the hilum of both lungs was not large (shown by arrows in Figures A and B). In order to confirm the diagnosis and treatment, thoracoscopic wedge resection of the right lower lobe of the lung under general anesthesia was performed on October 25, 2024. The pathological results showed that the lymphoid tissue in the right lower lobe of the lung tissue diffusely proliferated and invaded blood vessels, and abnormal large lymphocytes were seen in the background of small lymphocytes, and large lymphocytes were diffusely distributed in patches in some areas (Figure C, hematoxylin-eosin staining ×100). In situ hybridization showed positive expression of Epstein-Barr virus-encoding RNA in situ hybridization (EBER-ISH) in tumor cells (panel D, chromogenic in situ hybridization ×400). Immunohistochemistry showed positive expression of CD20 and MUM1 in tumor cells, CD30 (scattered positive,<5%), CD3, BCL6, CD10, CD21 were all negative, combined with histopathology, immunohistochemistry and Epstein-Barr virus detection results were positive, consistent with lymphomatoid granuloma (LYG), grade 3. LYG is a rare vasocentric and vasodestructive lymphoproliferative disease that occurs outside lymphoid organs. It consists of Epstein-Barr virus-positive B cells and reactive T cells. The distribution of nodular LYG was mainly in the middle and lower lung fields, and the nodules were mostly irregular, with less sharp edges but no obvious burrs. After enhanced imaging scan, nodular LYG mostly showed mild to moderate uniform enhancement. The pathology of LYG is characterized by vasocentric and vasodestructive pleomorphic lymphoid infiltration. Treatment includes drugs that act on the immune system, chemotherapy, and bone marrow transplantation.