대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Diffuse pulmonary meningotheliomatosis

Radiologic Findings

Plain chest radiograph shows no abnormal finding.
Chest CT demonstrates multiple bilateral randomly distributed ground-glass attenuation micronodules. Many nodules show central cavitation. No zonal predominance is seen.
VATS biopsy was done in the right middle and 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.

Keywords

Lung,