Inflammatory pseudotumor of the lung. Case report.
Rev Port Cir Cardiotorac Vasc.
2007 January-March;14(1):21-25
Inflammatory
pseudotumor of the lung is a rare entity, of unknown etiology and
variable clinical evolution. The histological variety of this entity
makes the diagnosis difficult, which is generally obtained after
surgical removal of the lesion. The authors report the clinical case
of a 32 years old woman presenting with hemoptysis and radiologic
appearance of aspergilloma. The lesion was surgically removed and the
diagnosis of inflammatory pseudotumor of the lung was confirmed by
pathologic and immunohistochemical analysis.
Inflammatory
pseudotumor of the lung: clinicopathological analysis in seven adult
patients.
Int J Clin Oncol. 2006
Dec;11(6):461-6.
BACKGROUND: As
the origin and pathology of inflammatory pseudotumor is not clearly
understood, there has recently been some confusion regarding the
diagnosis of inflammatory pseudotumor. METHODS: We performed
clinicopathological analyses in seven patients with inflammatory
pseudotumors of the lung histologically diagnosed after surgical
resection. The seven patients, selected from patients admitted to
Kawasaki Medical School Hospital between April 1989 and December 2005,
consisted of four men and three women (average age, 60.4 years). The
detection method was from clinical symptoms in two patients and from
health examinations in five patients. RESULTS: Five patients had a
solitary nodular shadow on chest radiographs and the other two
patients had multiple shadows. Because it was difficult to distinguish
pseudotumor from lung cancer by chest computed tomography in the five
patients showing a solitary nodular shadow, the final diagnosis was
obtained by surgical resection. In the other two patients, with
multiple shadows, one of whom had nodular shadows with cavitary
lesions, surgical resection was performed to distinguish the
pseudotumor from metastatic lung cancer. The histological types
according to the criteria of Matsubara were fibrous histiocytic in
five patients, organizing pneumonia in one, and lymphoplasmocytic in
one. The histological types according to the World Health Organization
criteria were compact spindle-cell pattern in six patients and
hypocellular fibrous pattern in one. CONCLUSION: Because it is
difficult to make a preoperative diagnosis of inflammatory pseudotumor
by radiological findings or histological findings using specimens
obtained by transbronchial lung biopsy, surgical resection, such as
video-assisted thoracic surgery or open lung biopsy, is required to
differentiate inflammatory pseudotumors from primary or metastatic
lung cancers.
Plasma cell
granuloma associated with pulmonary actinomycosis: a case report.J
Korean Med Sci. 2006 Dec;21(6):1117-20.
Plasma cell granuloma (PCG) of
the lung is a rare disease that usually presents as a pulmonary nodule
or mass on incidental radiographic examination without symptoms.
Although the etiology of PCG is still controversial, many findings
have lent support to the lesion being a reactive inflammatory process
rather than a neoplastic one. We describe a 53-yr-old male who
presented with a hemoptysis and have a lung mass at the left upper
lobe on chest radiograph. The lung mass was primarily diagnosed as PCG
by percutaneous needle aspiration and biopsy, and the patient was
treated with oral steroid because he and relatives refused the
operation. However, the size of the lung mass did not change and open
thoracotomy and lobectomy were done therefore. He was confirmed as
having pulmonary actinomycosis with PCG after surgery. To our
knowledge, this is the first report of PCG associated with
actinomycosis in Korea.
Pulmonary inflammatory
pseudotumor: difficulties in diagnosis and prognosis.Tunis
Med. 2006 Mar;84(3):205-8.
Inflammatory
pseudotumors are uncommon benign lesions of the lung of unknown
origin, that may show aggressive behavior. Although pseudotumors
constitute less than 1% of all lung tumors, they are reported to be
the most common cause of solitary lung masses in children. Complete
resection, when possible, is safe and leads to excellent survival. The
case presented here highlights difficulties in clinical and histologic
diagnosis.
Inflammatory pseudotumor: a rare
cause of proximal bronchial obstruction.
Rev Pneumol Clin. 2006 Jun;62(3):183-6.
Inflammatory pseudotumor
of the lung is a rare disease with usual benign course. Relapse after
incomplete resection and aggressive forms have already been described.
We report the case of a 67-year-old woman with atelectasis of the left
lung related to an endobronchial inflammatory pseudotumor. After laser
resection, relapse occurred 3 months later, requiring surgical
treatment.
A case of pulmonary
inflammatory pseudotumor: Recurrence appearing as several
consolidative lesions after complete resection.Korean
J Intern Med. 2005 Jun;20(2):168-72.
Inflammatory pseudotumor
(plasma cell granuloma) of the lung is an uncommon nonneoplastic tumor
of unknown origin. This tumor typically manifests as a solitary,
peripheral, and sharply circumscribed mass. Multiple lesions are seen
in about 5% of cases. Resection is recommended for both diagnosis and
treatment, and this tumor does not generally recur after complete
resection. Here, we report a case of recurrent inflammatory
pseudotumor after complete resection; the recurrence was detected as a
series of bilateral consolidated lesions with an internal air
bronchogram. This is an unusual finding with regard to inflammatory
pseudotumors.
IgG4-positive plasma cells in
inflammatory pseudotumor (plasma cell granuloma) of the lung.Hum
Pathol. 2005 Jul;36(7):710-7.
The association between IgG4
dysregulation and inflammatory pseudotumor (IPT) was first reported in
sclerosing pancreatitis. Recently, we described IPTs of the liver and
breast, into both of which many IgG4-positive plasma cells had
infiltrated. In this study, we examined the clinical and histological
features of 9 cases of IPT (histologically corresponding to plasma
cell granuloma) of the lung with an emphasis on IgG4-positive plasma
cell infiltration. The lesions were characterized histologically by
dense lymphoplasmacytic infiltrates intermixed with fibrosis and, in
some cases, prominent eosinophilic infiltration, irregular narrowing
of bronchioles entrapped in nodules, and an interstitial pneumonia
pattern at the boundaries of nodules. Obliterative phlebitis was
easily found in all cases, and 5 lesions also had obliterative
arteritis. Immunostaining revealed many IgG4-positive plasma cells
diffusely distributed within nodules, and the ratios of IgG4-positive
to other plasma cells were extraordinarily high. Of the 9 patients, 8
underwent surgical treatment and in 1 patient, lesion was diagnosed on
transbronchial biopsy and effectively treated with corticosteroid. Two
cases were associated with chronic sclerosing sialadenitis or
lymphadenopathy, in which many IgG4-positive plasma cells were also
identified by immunostaining. The clinicopathologic similarities
between IPT of the lung and sclerosing pancreatitis suggest that
IgG4-related immunopathologic processes might be involved in the
pathogenesis of the pulmonary lesions.
Inflammatory
pseudotumors of the lung with spontaneous regression.J
Med Liban. 2005 Oct-Dec;53(4):229-33.
Inflammatory pseudotumors of
the lung can be confusing in their presentation because they lack
specific symptoms clinically and can easily be mistaken for malignancy
on imaging studies. Their definite diagnosis requires pathologic
analysis of tissue which is usually obtained only after surgical
resection of the lesion. We report herein the case of a 65-year-old
man who presented with recent onset of cough, shortness of breath and
hemoptysis. CT scan of the chest showed several ill-defined suspicious
densities in both lungs. CT guided needle core biopsy of one of the
nodules showed changes consistent with inflammatory pseudotumor of the
lung without any evidence of malignancy. The pulmonary lesions, which
had rapidly progressed initially, resolved completely with simple
clinical observation. The total regression of the "tumor nodules" in
this case, without any treatment, illustrates a very unusual outcome
of these pseudotumors.
Unusual cause of dysphagia:
inflammatory pseudotumor of the lung.South
Med J. 2005 Jun;98(6):665-8.
Inflammatory pseudotumor (IPT)
is a rare disease that usually occurs in the lung. Patients with IPT
are usually asymptomatic, with a solitary pulmonary nodule or mass
detected on routine chest roentgenogram. IPT can behave as a malignant
tumor both clinically and radiologically. Cough, fever, dyspnea, and
hemoptysis are the usual presenting symptoms. This report describes
the case of a 37-year-old man with a 4-month course of dysphagia
secondary to lower esophageal invasion by the posterior mediastinal
extension of a lung IPT.
Diagnosis and surgical
treatment of inflammatory pseudotumor of the lung: a report of 51
cases.Ai
Zheng. 2005 Feb;24(2):219-21.
BACKGROUND & OBJECTIVE:
Clinical symptoms and imaging presentations of inflammatory
pseudotumor of the lung (IPL) lack of specialties, and always result
in misdiagnoses. This article was to summarize features of IPL, and to
improve diagnosis accuracy and appropriate operation selection.
METHODS: Records of 51 patients with pathologically confirmed IPL,
treated surgically in Department of Thoracic Surgery, Cancer
Institute/Hospital, Chinese Academy of Medical Sciences from Jan. 1990
to Mar. 2000, were retrospectively reviewed. All patients were
followed-up for at least 3 years. RESULTS: Of the 51 patients, before
operation, only 3 (5.9%) had been correctly diagnosed, 24 (47.1%) were
suspected having tuberculoma or other benign lung tumors, 10 (19.6%)
with undefined occupied lesion in the lung, 14 (27.4%) were
misdiagnosed as lung cancer. All patients received surgery, including
lobectomy in 23 patients (45.1%), tumor excision in 22 patients
(43.1%), wedge resection in 4 patients (7.8%), and segmental resection
in 2 patients (3.9%). Only 1 (2.0%) had postoperative complication. No
death occurred with a follow-up rate of 94.1% (48/51). CONCLUSION:
Preoperative diagnosing IPL is quite difficult. Surgery should be
performed as early as possible. The selection of surgery patterns,
mainly include lobectomy and limited resection, depends on
intraoperative pathology.
Inflammatory pseudotumor of
the lung in adults.
Ann
Thorac Surg. 2005 Feb;79(2):426-32.
BACKGROUND: Thoracic surgeons
have limited experience of inflammatory pseudotumors of the lung owing
to their rare occurrence in routine clinical practice. METHODS: We
retrospectively investigated the clinicopathologic features of 18
patients with inflammatory pseudotumor of the lung observed between
1992 and 2002. RESULTS: There were 13 men and 5 women. Median age was
57 years. Eight patients (44%) were symptomatic. Computed tomographic
scan showed a solitary nodule (< or =3 cm) in 12 patients, bilateral
nodules in 1, and a mass in 5. Two patients had undergone prior
incomplete resections. Lobectomy was performed in 5 patients,
bilobectomy in 1, segmentectomy in 1, and wedge resection in 11.
Complete resection was achieved in 13 patients (72%). There was no
operative mortality. Follow-up was complete in all patients (range, 13
to 134 months; median, 63 months). Overall 3-year and 5-year survival
rates were 82% and 74%, respectively. Thirteen patients are currently
alive with no evidence of disease, 1 is alive with disease, 1 died of
unrelated causes, and 3 had a relapse and died. Completeness of
resection and lesion size less than or equal to 3 cm were associated
with a better survival (p < 0.001 and p = 0.007, respectively).
Multivariate Cox analysis confirmed the association between
completeness of resection and better survival, which is independent of
other clinicopathologic variables (p = 0.02). CONCLUSIONS: This series
shows that a significant number of patients with inflammatory
pseudotumor of the lung have a poor prognosis and confirms the need
for radical resection in the treatment of this unusual entity.
Paraneoplasic syndrome in inflammatory pseudotumor of the lung.Cir
Pediatr. 2004 Apr;17(2):98-100.
BACKGROUND: Inflammatory
pseudotumor (IPT) is the most frequent pulmonary mass in childhood. It
is histologically benign but locally aggressive. Atelectasis and
recurrent airway infections are the most frequent presenting findings.
We present two children in whom first clinical signs were
paraneoplasic syndromes. MATERIAL AND METHODS: Retrospective study of
two cases of IPT treated in our clinic from 1998 to 2002. Age,
clinical presentation, preoperative diagnosis, treatment, histological
diagnosis and postoperative outcome were reviewed from clinical chart.
RESULTS: Case 1: 7 year old male with incidental diagnosis of superior
right lobe IPT in routine study because of diabetes. The mass
collapsed superior and median lobar arteries and compressed superior
cava vein. Right pneumonectomy was necesary to complete removal of the
mass. From immediate postoperatory the child became normoglycemic and
is free of insulin. Case 2: 11 year old male with rheumatologic clinic
consisting in hypertrophic osteoarthropathy, arthralgy and knees
liquid lasting for two years. X-ray examination showed mediastinic
mass. He underwent complete removal of a pulmonary mass. Few months
after the operation the rheumatologic-like symptoms were resolved.
CONCLUSIONS: IPT can present with paraneoplasic syndromes, although
physiopathology is not well understood. In children with recurrent
respiratory infections one diagnosis to take in mind is IPT, even more
when clinic is associated with symptoms compatible with paraneoplasic
syndrome.
Pulmonary inflammatory
pseudotumor--a report of 28 cases.Korean
J Intern Med. 2002 Dec;17(4):252-8.
BACKGROUND: Pulmonary
inflammatory pseudotumor is an uncommon benign lesion of the lung. In
Korea, most literature of the pulmonary inflammatory pseudotumor was
case reports. METHODS: We collected 28 cases of pulmonary inflammatory
pseudotumor in Korea. This collective series included 4 cases from our
hospital and 24 cases were reviewed from the literature since 1977.
The analysis involved the age, sex, chief complaint, hematologic
examination, size and location of the lesion, cavity formation,
presence of calcification and treatment method. RESULTS: Male was more
prevalent (81.5%) than female and mean age was 37.9 years old (6-63
yrs). Chief complaints were cough (44.4%), chest pain (29.6%), fever
(22.2%), hemoptysis (15%), sputum (15%) and dyspnea (11.1%). There
were asymptomatic cases in 11.1%. Hematologic examination revealed
normal finding (53.3%) and anemia (20%). The mean size of the lesion
was 4.76 cm (1.5-14 cm) and the locations were parenchymal (85.7%),
endobronchial (10.7%) and endotracheal (3.6%). Except the endotracheal
case, the lesions were in the right (46.4%), the left (42.8%) and
bilateral (7.1%). Calcifications (18.5%) and cavitations (11.1%) were
present. Diagnostic methods were open thoracotomy (82.1%),
bronchoscopy (3.6%), needle aspiration biopsy (7.1%) and core needle
gun biopsy (7.1%). Treatments were surgery (85.2%), steroid therapy
(7.4%), rigid bronchoscopic removal (3.7%) and observation (3.7%).
Postoperative recurrence occurred in only 1 case (4.3%). CONCLUSION:
Pulmonary inflammatory pseudotumor was more prevalent in the male, and
patients presented with the respiratory symptoms were common. It was
necessary to do surgery in most cases for diagnosis and/or treatment.
A case report of
inflammatory pseudotumor of the lung: rapid recurrence appearing as
multiple lung nodules.Ann
Thorac Cardiovasc Surg. 2002
Aug;8(4):224-7.
An inflammatory pseudotumor (IPT),
known as a plasma cell granuloma, is a relatively uncommon neoplasm
with an unidentified etiology. To our knowledge, an early relapse with
multiple lung nodules following lung resection and occurrences in
multiple organs is extremely rare. The patient was a 49-year-old man
who presented with left chest pain and fever. A chest film
demonstrated an 8x8 cm mass in the left lower lobe. During thoracotomy
in April 2001, a mass was seen to have invaded the diaphragm with
remarkable pleural adhesion. The intraoperative pathological diagnosis
was infiltration of inflammatory cells with no malignancy. Therefore,
a partial resection of the left lower lobe was performed. Three months
after the thoracotomy, a chest CT scan disclosed multiple nodular
opacities bilaterally, and an open lung-biopsy of the right lung was
performed in January 2002. His past history included an excision of a
mass on the penis in another hospital in 1994 and a subcutaneous mass
that appeared on the right thigh and disappeared spontaneously
following a needle biopsy in 1999. Pathologically there was no
fundamental difference among his present lesion and the former two.
The pathological diagnosis at each occurrence was inflammatory
pseudotumor (IPT). In immunohistochemical study, the staining with
smooth muscle actin cells was positive, but was negative for the
staining with anaplastic lymphoma kinase (ALK). With no evidence of a
neoplastic process, these histopathological and immunohistochemical
findings could imply that this case may be a postinflammatory
reparative reaction, although his condition exhibited the clinically
aggressive behavior of suspected lung metastasis.
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