Surgery Today

, Volume 26, Issue 6, pp 431–434

Nodular lymphoid hyperplasia of the terminal ileum: Report of a case and the findings of an immunological analysis

  • Hiroki Yamaue
  • Hiroshi Tanimura
  • Kiwao Ishimoto
  • Yoshihiro Morikawa
  • Kennichi Kakudo
Case Reports


The immunological and immunohistochemical characteristics of a patient with nodular lymphoid hyperplasia (NLH) of the terminal ileum were investigated pre- and post-operatively. The patient presented with diarrhea, lower abdominal pain, and weight loss, and an abdominal X-ray following barium enema revealed multiple small nodules in the terminal ileum which were subsequently confirmed to be NLH by histological examination. Preoperatively, although the serum immunoglobulin levels were normal, the T-cell responses in the peripheral blood, including the phytohemagglutinin (PHA)-blastogenesis and the T4/T8 ratio, were impaired. However, following an ileocecal resection, the PHA-blastogenesis became augmented and the T4/T8 ratio recovered to within the normal range. The immunohistochemical findings revealed a more marked accumulation of T cells in the interstitium around the hyperplastic follicles than in the interstitium of the normal intestine.

Key Words

nodular lymphoid hyperplasia ileum humoral immunity immunohistochemical staining 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ranchod M, Lewin KJ, Dorfman RF (1987) Lymphoid hyperplasia of the gastrointestinal tract. A study of 26 cases and review of the literature. Am J Surg Pathol 2:383–400Google Scholar
  2. 2.
    Bastlein C, Burlefinger R, Holzberg E, Voeth CH, Garbrecht M, Ottenjann R (1988) Common variable immunodeficiency syndrome and nodular lymphoid hyperplasia in the small intestine. Endoscopy 20:272–275Google Scholar
  3. 3.
    Ward H, Jalan KN, Maitra TK, Agarwal SK, Mahalanabis D (1983) Small intestinal nodular lymphoid hyperplasia in patients with giardiasis and normal serum immunoglobulins. Gut 24:120–126Google Scholar
  4. 4.
    Matuchansky C, Tuchard G, Lemaire M, Babin, P, Demeocq F, Fonck Y, Meyer M, Preud'homme J (1985) Malignant lymphoma of the small bowel associated with diffuse nodular lymphoid hyperplasia. N Engl J Med 313:166–171Google Scholar
  5. 5.
    Rambaud J, Saint-Louvent P, Marti R, Galian A, Mason DY, Wassef M, Licht H, Valleur P, Bernier J (1982) Diffuse follicular lymphoid hyperplasia of the small intestine without primary immunoglobulin deficiency. Am J Med 73:125–132Google Scholar
  6. 6.
    Harris M, Blewitt RW, Davies VJ, Steward WP (1989) High-grade non-Hodgkin's lymphoma complicating polypoid nodular lymphoid hyperplasia and multiple lymphomatous polyposis of the intestine. Histopathology 15:339–350Google Scholar
  7. 7.
    Charlesworth D, Fox H, Mainwaring AR (1970) Benign lymphoid hyperplasia of the terminal ileum. Am J Gastroenterol 53:579–584Google Scholar
  8. 8.
    Crawford AP (1979) Lymphoid hyperplasia of small bowel in an adult female. Med J Aust 1:531–532Google Scholar
  9. 9.
    Stueland DT, Binkley NC, Magnin GE (1980) Symptomatic benign lymphoid hyperplasia of the terminal ileum in an adult. Am J Gastroenterol 74:522–524Google Scholar
  10. 10.
    Molas G, Potet F, Nagig P (1985) Hyperplasie lymphoide focale (pseudolymphome) de l'iléum terminal chez l'adulte. Gastroenterol Clin Biol 9:630–635Google Scholar
  11. 11.
    Rubin A, Isaacson PG (1990) Florid reactive lymphoid hyperplasia of the terminal ileum in adults: a condition bearing a close resemblance to low-grade malignant lymphoma. Histopathology 17:19–26Google Scholar
  12. 12.
    Caballero FM, Brown WR, Kohler PF, Hayward AR (1984) B cell numbers and responses in patients with common variable immunodeficiency and nodular lymphoid hyperplasia of the bowel. J Clin Lab Immunol 13:59–63Google Scholar
  13. 13.
    Lamers CBHW, Wagener T, Assmann KJM, Van Tongeren JHM (1980) Jejunal lymphoma in a patient with primary adult-onset hypogammaglobulinemia and nodular lymphoid hyperplasia of the small intestine. Digest Dis Sci 25:553–557Google Scholar
  14. 14.
    Tytgat GN, Huibregtse K, Schellekens PA, Feltkamp-Vroom TH (1979) Clinical and immunologic observations in a patient with late-onset immunodeficiency. Gastroenterology 76:1458–1465Google Scholar
  15. 15.
    Khojasteh A, Haghshenass M, Haghighi P (1983) Immunoproliferative small intestinal disease: A “Third-World lesion”. N Engl J Med 308:1401–1405Google Scholar
  16. 16.
    Essenfeld-Sekler E, Paez CC, Toledano A, Congedo E, Guelrud M, Roa E (1979) Bleeding lymphoid hyperplasia of the small bowel in an adolescent diagnosed by intraoperative endoscopy. Gastrointest Endosc 25:21–22Google Scholar
  17. 17.
    Nagura H, Kohler PF, Brown WR (1979) Immunocytochemical characterization of the lymphocytes in nodular lymphoid hyperplasia of the bowel. Lab Invest 40:66–73Google Scholar
  18. 18.
    Brande PVD, Geboes K, Vantrappen G, Van den Eeckhout A, Vertessen S, Stevens EAM, Ceuppens JL (1988) Intestinal nodular lymphoid hyperplasia in patients with common variable immunodeficiency: Local accumulation of B and CD8 (+) lymphocytes. J Clin Immunol 8:296–306Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Hiroki Yamaue
    • 1
  • Hiroshi Tanimura
    • 1
  • Kiwao Ishimoto
    • 1
  • Yoshihiro Morikawa
    • 2
  • Kennichi Kakudo
    • 2
  1. 1.Department of Gastroenterological SurgeryWakayama Medical SchoolWakayamaJapan
  2. 2.Department of PathologyWakayama Medical SchoolWakayamaJapan

Personalised recommendations