Discussion
Diagnosis With Brief Discussion
- Courtesy
- Asan Medical Center, Seoul Korea
- Definitive Diagnosis
- Diagnostic methods
Excisional biopsy
Gross pathology; a well defined grayish tan and fibrotic mass
Lung, wedge resection:
- Inflammatory mass - like lesions, consistent with plasma cell granulomas
- No evidence of malignancy
- Discussion
- Brief Discussion
Plasma cell granuloma (Inflammatory pseudotumor)
-Quansineoplastic lesion consisting of inflammatory cells and myofibroblastic spindle cells
-Lung, orbit, nearly every site in the body
-Pathogenesis: Unknown
1) Low grade fibrosarcoma
2) Inflammation following minor trauma or surgery
3) Secondary to infection
Pulmonary inflammatory pseudotumor
Most common primary lung mass in children
No sex predilection, peak age in second decade
Clinical manifestation: Usually asymptomatic, cough, fever, dyspnea, and hemoptysis
20%: antecedent pulmonary infection
Three histologic types
1) Organizing pneumonia pattern: characterized by airways filled with plump fibroblasts and foamy histiocytes and parenchyma replaced with a mixture of histiocytes, mononuclear cells, and fibroblasts
2) Fibrous histiocytic pattern: spindle-shaped myofibroblasts arranged in whorls
3) Lymphohistocytic pattern: mixture of lymphocytes and plasma cells with only minimal fibrous connective tissue
Radiologic findings
-CXR: solitary, peripheral, sharply circumscribed, lobulated mass
-CT: Variable, nonspecific heterogeneous attenuation and enhancement
-MR: Intermediate signal intensity on T1WI, high SI on T2WI
-Multiple lesions: 5%
Treatment: Surgical resection, high-dose steroid, irradiation, chemotherapeutic agent
Prognosis: Local recurrence (25%), rare distant metastasis and spontaneous remission
Radiologic differential diagnosis
-Solitary pulmonary nodule: primary or secondary neoplasm, hamartoma, chondroma, hemangioma, granuloma. Pulmonary sequestration
-Multiple nodules: metastasis
- Reference
- Plasma cell granuloma (Inflammatory pseudotumor)
-Quansineoplastic lesion consisting of inflammatory cells and myofibroblastic spindle cells
-Lung, orbit, nearly every site in the body
-Pathogenesis: Unknown
1) Low grade fibrosarcoma
2) Inflammation following minor trauma or surgery
3) Secondary to infection
Pulmonary inflammatory pseudotumor
Most common primary lung mass in children
No sex predilection, peak age in second decade
Clinical manifestation: Usually asymptomatic, cough, fever, dyspnea, and hemoptysis
20%: antecedent pulmonary infection
Three histologic types
1) Organizing pneumonia pattern: characterized by airways filled with plump fibroblasts and foamy histiocytes and parenchyma replaced with a mixture of histiocytes, mononuclear cells, and fibroblasts
2) Fibrous histiocytic pattern: spindle-shaped myofibroblasts arranged in whorls
3) Lymphohistocytic pattern: mixture of lymphocytes and plasma cells with only minimal fibrous connective tissue
Radiologic findings
-CXR: solitary, peripheral, sharply circumscribed, lobulated mass
-CT: Variable, nonspecific heterogeneous attenuation and enhancement
-MR: Intermediate signal intensity on T1WI, high SI on T2WI
-Multiple lesions: 5%
Treatment: Surgical resection, high-dose steroid, irradiation, chemotherapeutic agent
Prognosis: Local recurrence (25%), rare distant metastasis and spontaneous remission
Radiologic differential diagnosis
-Solitary pulmonary nodule: primary or secondary neoplasm, hamartoma, chondroma, hemangioma, granuloma. Pulmonary sequestration
-Multiple nodules: metastasis
- Keywords
-
Lung, Non-infectious inflammation,