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Case Reports
. 2025 Nov 20:13:2050313X251395978.
doi: 10.1177/2050313X251395978. eCollection 2025.

Three-dimensional visualization of an unusual pulmonary lymphoproliferation after COVID-19

Maximilian Ackermann  1   2   3 , Jakob Reichmann  4 , Jakob Frost  4 , Tobias Welte  5   6 , Stijn E Verleden  7 , Tim Salditt  4 , Danny D Jonigk  1   6 , Reinhard Pabst  8
Affiliations
Case Reports

Three-dimensional visualization of an unusual pulmonary lymphoproliferation after COVID-19

Maximilian Ackermann et al. SAGE Open Med Case Rep. .

Abstract

The following case report details the case of a 40-year-old Caucasian patient who presented with dyspnea following a serologically confirmed mild-to-severe pulmonary infection with SARS-CoV-2. Chest computer tomography revealed a solitary ground-glass pulmonary nodule in the lower right lobe, measuring 2.1 cm in diameter. Video-assisted thoracoscopic surgery wedge resection revealed well-circumscribed lymphoid aggregates adjacent to the round, smaller airways, bronchioles, and blood vessels. IgKappa B exhibited a monoclonal polyclonal pattern, in contrast to the behavior exhibited by IgKappa A and IgLambda. In the following discussion, the lymphoid lesion was considered in the context of lymphoid hyperplasia, accompanied by an early infiltration of low-grade extranodal B cell lymphoma of the bronchus-associated lymphoid tissue (BALToma).

Keywords: BALToma; SARS-CoV2; bronchus-associated lymphoid tissue; multiscale X-ray phase-contrast computed tomography.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Paraffin-embedded lung tissue was analyzed by multiscale XPCT. (a–c) XPCT-scan could reveal the peribronchial, nodular infiltration of a lymphoid aggregates with GCs (rendered GCs in c) in the BALT. (d) XPCT scan demonstrates the perivascular spreading of lymphoid cells within and surrounding BALT. (e) Segmentation of vascularity is characterized by altered severely abnormal-appearing blood vessels (yellow) which are directly linked to the upstream larger blood vessels (f). XPCT: X-ray phase-contrast computed tomography; GCs: germinal centers; BALT: bronchus-associated lymphoid tissue.
Figure 2.
Figure 2.
(a–c) Scanning electron micrographs of resected lung tissue illustrated the substantial infiltration of a peribronchiolar and perivascular (white asterisk) lymphoid aggregates (blue arrows) and prominent vascular proliferations with intussusceptive pillars (d, arrowheads). alv: alveolus.
Figure 3.
Figure 3.
Immunohistochemical assessment of the peribronchial and perivascular lymphoid infiltrate revealed strong CD20- and Bcl2-positivity of germinal centers (CD20, CD23) and the paracortical lymphoid neoplasia with scattered T cells (CD3). Proliferation was slightly elevated in the paracortical zone.
Figure 4.
Figure 4.
Schematic drawing of BALT in distribution of lymphocyte subsets is shown as in BALT of children. Three main compartments are: (1) Central follicular vein with accumulation of B lymphocytes. (2) The parafollicular area with mainly T lymphocytes and specialized HEV and (3) the dome area with a specialized epithelium lacking goblet cells. Various efferent and afferent autonomic nerves are indicated. There are efferent lymph vessels that drain to the regional parabronchial lymph nodes (with permission by Pabst). HEV: high-endothelial venules.
See this image and copyright information in PMC

References

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