대한흉부영상의학회 Weekly Chest Cases

Case No : 1063 Date 2018-03-12

Courtesy of Junghoon Kim, Kyung Won Lee / Seoul National University Bundang Hospital
Age/Sex 58 / F
Chief ComplaintIncidental finding

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Diagnosis With Brief Discussion

Diagnosis: Diffuse pulmonary meningotheliomatosis
Radiologic Findings: 1. Plain chest radiograph shows no abnormal finding.
2-4. Chest CT demonstrates multiple bilateral randomly distributed ground-glass attenuation micronodules. Many nodules show central cavitation. There is a tendency to be located in the periphery of the lower lung.

VATS biopsy was done in the right lower lobe and diffuse pulmonary meningotheliomatosis was confirmed.
Brief Review: Pulmonary meningothelial-like nodules (PMLNs) have been found in patients ranging in age from 12 to 91 years, mostly in the seventh decade of life with a marked female predilection. Pathologically, PMLNs are small (100 um to a few mm) nodules which are composed of cells similar with meningothelial cells. Most PMLNs are usually solitary and found incidentally without related clinical manifestations during testing for other diseases. However, multiple lesions can be encountered and have occurred in up to 41% of all patients with PMLNs. If these lesions are small and numerous, this condition has been termed as diffuse pulmonary meningotheliomatosis (DPM).
Radiologic features of DPM are nonspecific, but, scattered minute areas of ground-glass attenuation are characteristic. The lesions presented in a random distribution but had a tendency to be located in the periphery of the lung. There is an assumption that the spread of the lesion along the alveolar walls likely results in the ground-glass attenuation on HRCT.
It has benign course, thus, conservative treatment is favorable. Therefore, this entity should be distinguished from metastatic carcinomas with prominent lymphatic spread in the lungs. However, recent studies reported that DPM have been associated with a variety of pulmonary abnormalities including pulmonary thromboembolism, and neoplasm, particularly pulmonary adenocarcinoma.
References: 1. An J, et al. Diffuse pulmonary meningotheliomatosis. Korean J Pathol. 2011; 45(S1): S32-35.
2. Suster S, Moran CA. Diffuse pulmonary meningotheliomatosis. Am J Surg Pathol. 2007 Apr;31(4):624-31.
3. Kraushaar G, et al. Minute pulmonary meningothelial-like nodules: a case of incidentally detected diffuse cystic micronodules on thin-section computed tomography. J Comput Assist Tomogr. 2010;34: 780-782.
4. Kuroki M, et al. Minute pulmonary meningothelial-like nodules: high-resolution computed tomography and pathologic correlations. J Thorac Imaging. 2002;17(3):227-229.
Please refer to: Case 853
Keywords: Lung, Benign neoplasm,

No. of Applicants : 115

▶ Correct Answer : 39/115, 33.9%

- Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- Chonbuk National University Medical School , Korea (South) HYEJIN YANG
- King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
- Gifu University Hospital , Japan TOMOHIRO ANDO
- Chonbuk National University Hospital , Korea (South) MINGI SHIN
- McGill University Health Center , Canada Alexandre Semionov
- NIMS, HYDERABAD , India BHASKAR K
- Chonbuk National University Hospital , Korea (South) SANGHEON KIM
- Chonbuk National University Hospital , Korea (South) EUN HA JUNG
- Chonbuk National University Hospital , Korea (South) JAEYEONG JEONG
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Chonbuk National University Hospital , Korea (South) SANGJIN PARK
- Oita University, Faculty of Medicine , Japan Fumito Okada
- The Jikei university , Japan TAKU GOMI
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Ajou University Hospital , Korea (South) Taeyang Ha
- Asan Medical Center , Korea (South) JOOAE CHOE
- Gifu University Hospital , Japan Yo Kaneko
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
- CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Other , Korea (South) HAYEON LEE
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Yonsei University,Severance Hospital , Korea (South) KYUNGSUN NAM
- Ajou University Hospital , Korea (South) HYERIN KIM
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Multimagem Diagn泥sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
- Chonbuk National University Hospital , Korea (South) WEON JANG
- Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
- Teikyo University Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Hamamatsu university school of medicine , Japan YUKI HAYASHI
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Samsung Medical Center , Korea (South) HYUN JUNG YOON
- Ajou University Hospital , Korea (South) YOO YOUNGJIN

▶ Correct Answer as Differential Diagnosis : 5/115, 4.3%

- Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
- Other , Korea (South) SEONGSU KANG
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Fortis hospital , Mohali , India SHALEEN RANA

▶ Semi-Correct Answer : 1/115, 0.9%

- university of montreal , Canada Andrei Bogdan Gorgos I

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1063 Date 2018-03-12

Discussion

No. of Applicants : 115