Stanford School of Medicine

Surgical Pathology Criteria

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Follicular Bronchiolitis / Bronchitis


  • Reactive lymphoid follicles localized to peribronchiolar and peribronchial tissues

Alternate/Historical Names

  • BALT hyperplasia

Diagnostic Criteria

  • Clinical
    • Gradual onset of dyspnea, cough
    • May occur at any age
    • Frequently associated with immune related diseases
      • Autoimmune diseases including collagen vascular
      • Immunodeficiency including AIDS and common variable immunodeficiency
    • May have hyper or hypogammaglobulinemia gammopathy
    • Most respond to steroids
  • High resolution computed tomography (HRCT)
    • Centrilobular and occasionally peribronchial nodules
  • Histopathologic features
    • Scattered reactive lymphoid follicles around bronchioles and bronchi
      • Lymphoid nodules may be >1 mm diameter
      • May compress bronchiole lumens
        • Acute exudate may be seen in lumens
        • Distal changes of obstructive pneumonia may be seen
      • Occasional cases may also have a lymphangitic pattern involving septa and pleura
    • Mild infiltrate may extend into adjacent alveolar septa
    • Mixed polytypic B and T cells

Gerald J Berry MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting/updates: 11/20/10

Differential Diagnosis

Lymphocytic Interstitial Pneumonitis Follicular Bronchiolitis
Predominantly T cell infiltrate Prominent B cell follicles
Predominantly interalveolar Predominantly peribronchiolar
Occasional caess will show features of both


Follicular Bronchiolitis Extranodal Marginal Zone B Cell Lymphoma
Predominantly germinal centers Monomorphous infiltrate
Involvement of pleura and cartilage rare Pleura and cartilage may be involved
Dutcher bodies not seen Dutcher bodies may be seen
Polyclonal Monoclonal


Follicular Bronchiolitis Nodular Lymphoid Hyperplasia
Scattered follicles around bronchioles Numerous germinal centers form mass lesion or lesions


Follicular Bronchiolitis Hypersensitivity Pneumonitis
Fibroplasia is not typically seen Interstitial fibroblastic foci and intra-airway BOOP-like plugs usually present
No granulomas or giant cells Granulomas and giant cells generally present but may be infrequent in late stage
No fibrosis May develop peri-bronchiolar fibrosis with honeycomb change in later stage

Classification / Lists

Idiopathic Interstitial Lung Diseases

Other Diffuse Parenchymal Lung Diseases



  • Yousem SA, Colby TV, Carrington CB. Follicular bronchitis/bronchiolitis. Hum Pathol. 1985 Jul;16(7):700-6.
  • Guinee DG Jr. Update on nonneoplastic pulmonary lymphoproliferative disorders  and related entities. Arch Pathol Lab Med. 2010 May;134(5):691-701.
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