대한흉부영상의학회 Weekly Chest Cases

Case No : 516 Date 2007-09-17

Courtesy of Min Ji Kim, MD, Joo Sung Sun, MD, Kyung Joo Park, MD. / Department of Radiology, Ajou University School of Medicine, Korea.
Age/Sex 5 / M
Chief ComplaintRight chest pain for 2 weeks

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Diagnosis With Brief Discussion

Diagnosis: Inflammatory myofibroblastic tumor (Inflammatory pseudotumor)
Radiologic Findings: About 5-cm size well defined round mass is noted in right lower lung zone on plain radiography. On pre-enhanced CT scan, this mass shows smooth margin and homogenous density without calcification. On post-contrast CT scans, it reveals relatively homogenous strong enhancement (more than 40 HU) of this mass. Enlarged right interlobar lymph node is demonstrated (Not shown here).
Subsequent FDG PET/CT depicts homogenous and high uptake (pSUV=15.6) of mass without any other uptake focus.
Multiple sections reveal a relatively well demarcated partly encapsulated yellow gray solid mass with focal cystic degeneration and yellowish area (4.6x4.4cm) surrounded by lung parenchyma. There are many spindle cell (myofibroblast) and several inflammatory cell, and plasma cell on HPF (*400).
Brief Review: known as inflammatory pseudotumor (IPT)
- found in children and young adults, more common in women
- every site including lung, mesentery, retroperitoneum, pelvis
unknown etiology
- dominant spindle cell (myofibroblast) proliferation with inflammatory component
fever, splenomegaly
variable and nonspecific
- an uncommon cause of SPN (0.7 % of lung tumors)
CXR : a lenticular opacity is identified superimposed on the central portion of the lung on a chest radiograph
CT : typically a solitary, peripheral, sharply circumscribed mass with an anatomic bias for the lower lobes
MRI : T1 intermediate and T2 high
Other feature
- calcifications : not rare, more frequently in children than in adults (amorphous, mixed, or fine fleck-like to heavy)
- atelectasis and pleural effusion
- local invasion & primary involvement of the mediastinum and hilar structures : unusual
- multiple lung lesions, pneumonic consolidation, atelectasis, hilar masses, lymphadenopathy and cavitation : unusual
Please refer to
References
Keywords: lung, Benign tumor,

No. of Applicants : 51

▶ Correct Answer : 21/51, 41.2%

- Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Gimpo Woori Hospital, Korea Son Youl Lee
- Ruby Hall Clinic, Pune, India Nikhil Unune
- Ewha Womans University MokDong Hospital, Korea Yoo Kyung Kim
- Trakya University School of Medicine, Turkey Mustafa Kemal Demir
- Shiga University of Medical, Japan Norihisa Nitta
- Armidale Radiology, Australia Saurabh Khandelwal
- China Medical University Hospital, Taiwan Jun-Jun Yeh
- Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- Nour El-Islam Radiology Center Egypt .Alexandria Elsayed Mousa
- IRSA La Rochelle, France Jean-Luc BIGOT
- Armed Forces ChunCheon Hospital (AFCC), Korea Chae Hun Lim
- Kyunghee University Medical Center, Korea Su Youn Sim
- Homs National Hospital, Homs - Syria Rami Abou Zalaf
- Annecy hospital, France Gilles Genin
- IRSA, La Rochelle, France Denis Chabassiere
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Yongsan Hospital, College of Medicine Chung-Ang University, Korea Jae Seung Seo
- Jackson Memorial Hospital, Miami, Florida, USA N.B.S.Mani
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- CHU Grenoble, France Bing Fabrice

▶ Correct Answer as Differential Diagnosis : 6/51, 11.8%

- Ondokuz Mayis University, Samsun Turkey Cetin Celenk
- Pittwater Radiology, Australia Julie Arora
- KAUMS, Kashan, Iran Ebrahim Razi
- Nassau, Bahamas Trupti Dabholkar
- EKH-Berlin, Germany Michael Weber
- Max Hospital, New Delhi, India Vickrant Malhotra

▶ Semi-Correct Answer : 17/51, 33.3%

- Yashodha Hospital, Hyderabad, Andhra Pradesh, India Satish Babu, Maddkuri
- CHRU Lille hopital calmette, France Toledano Manuel
- Pune, India Rahul Deshmukh
- Aditya Imaging centre, Sayajigunj, Vadodara, Gujarat, India Vivek Patel
- E-Da hospital, Taiwan Yu-Feng Wei
- Regional Imaging Riverina, Australia Rashid Hashmi
- Osaka University, Japan Osamu Honda
- Balabhai Nanavati hospital, mumbai, India Susheel Kumar
- Soonchunhyang University Chunan Hospital, Korea Sang Hyun Park
- Nirman Hitech CT MR centre & Apollo clinic, Mumbai, India Jeshil Shah
- CHU, Grenoble, France Moroni Anne-Line
- Kangnam sacred hospital, Korea Kim Jae Won
- Sonexay RAJVONG, Saint-Etienne, France Antoine Marie
- Hospital Sotiria, Athens, Greece Vasilios Tzilas
- Apollo Hospitals, Bangalore, India R G Gopinath
- Vital imaging centre, Mumbai, India Ganesh Agrawal
- Ultracare Coimbatore, India Debabrata Das

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 516 Date 2007-09-17

Discussion

No. of Applicants : 51