Primary pulmonary lymphoma: a re-appraisal of its histogenesis and its relationship to pseudolymphoma and lymphoid interstitial pneumonia.

The clinical, morphological and immunohistochemical features of 15 cases of pulmonary lymphoproliferative disease are described. The diagnosis of primary pulmonary lymphoma was based in 13 cases on the demonstration of light chain restriction and in two cases on morphological characteristics. Many patients had a prolonged clinical course without significant clinical or radiographic deterioration, a feature associated with malignant lymphomas of mucosa-associated lymphoid tissue in other sites. Lymphoepithelial lesions were characteristic and malignant cells had the features of centrocyte-like cells, similar to those described in gastric and salivary gland lymphomas. Germinal centres were present in three cases: some were partially overgrown by centrocyte-like cells but residual polyclonal follicle centre cells and dendritic reticulum cells were still detectable. It is suggested that primary pulmonary lymphoma arises from centrocyte-like cells normally present in bronchus-associated lymphoid tissue. In addition to the malignant population, reactive follicles and polytypic plasma cells are frequently present and may prejudice interpretation of immunohistochemical features. In the light of these findings, cases previously diagnosed as pseudolymphoma or lymphoid interstitial pneumonia require careful assessment and the majority are, in reality, examples of primary pulmonary lymphomas.