Inflammatory pseudotumors of the lung

Reprint of: Unusual non-neoplastic lesions of the lung

Many nonneoplastic conditions that may affect the lung are in reality rare or unusual manifestations of metabolic processes, inflammatory conditions, or unknown etiology. Because of their rarity, they can often be confused with malignant neoplasms. Familiarity with these conditions not only will expedite further treatment for these patients but also will avoid the process of more tests or unnecessary surgical procedures. The nomenclature for some of those conditions is still controversial. The clinical outcome of these conditions can be quite variable, with some patients surviving a long number of years and others eventually succumbing to the disease. We will limit our discussion in this review to four of these conditions, including inflammatory pseudotumor (inflammatory myofibroblastic tumor), placental transmogrification of lung, alveolar microlithiasis, and metastatic calcification. Although these lesions are not part of the gamut of neoplastic conditions affecting the lung, they are nonetheless important to recognize, as their outcome may not necessarily be an innocuous one.

[Thoracic inflammatory pseudotumors : A rare differential diagnosis]

BACKGROUND

Inflammatory pseudotumors are a rare and in the main benign tumor entity but infiltrative growth, recurrence and metastases are described. Generally, a complete resection is needed to exclude lung cancer. This study analyzed our data and experiences with this rare tumor entity.

MATERIAL AND METHODS

We performed a retrospective study of all our patients who had been operated on between 2002 and 2016 in our institution for an inflammatory pseudotumor of the lungs. The extent of resection, morbidity, mortality and long-term results were analyzed.

RESULTS

Altogether, in this period 13 patients were operatively treated (5 women and 8 men). The median age was 52 years (range 34-74 years). A reoperation was carried out in one patient for recurrence after enucleation of the tumor in another hospital. In no case could lung cancer be excluded prior to complete resection. In total, 11 pulmonary, 1 tracheal and 1 chest wall pseudotumor could be resected by thoracotomy (9×) and thoracoscopy (3×) and 1 by ventral chest wall resection. In eight patients the resections were performed by standard resection (wedge resection or anatomic resection) and five times by extended resection. In all cases a R0 resection was achieved. Due to one case of postoperative pneumonia the morbidity and mortality rates were 7.7% and 0%, respectively.

CONCLUSION

The differential diagnosis between inflammatory pseudotumors and lung cancer cannot be definitely made preoperatively. For an exact diagnosis by the pathologist a complete histological preparation is needed. Due to infiltrative growth and recurrence, extended resection can be necessary for a R0 resection. This can be achieved with low morbidity and mortality. Important is an en bloc R0 resection, which is associated with good long-term results.

Cavitating lung lesion as a manifestation of inflammatory tumor (pseudotumor) of the lung: A case report and literature review

Patient: Female, 60

Final Diagnosis: Inflammatory pseudotumor of the lung

Symptoms: Cough dry • fever

Medication: —

Clinical Procedure: —

Specialty: —

Inflammatory pseudotumor of the thymus: A case report and review of the literature

Inflammatory pseudotumors are rare benign tumors consisting of cellular and stromal elements of a localized reactive process. While inflammatory pseudotumors are commonly detected in the lung and occasionally in other organs, only one case of inflammatory pseudotumor of the thymus has been reported in the literature to date. This report presents a 54-year-old male patient with inflammatory pseudotumor of the thymus accompanied by pulmonary inflammation. The patient presented with chest pain and moderate fever for 12 days. Enhanced computed tomography of the thorax revealed an anterior mediastinal solid and cystic mass, which constricted the left brachiocephalic vein accompanied by bilateral lung inflammation and marginal pleural effusion. The patient underwent a median sternotomy for the surgical removal of the mass. Histologically, the resected mass was composed of necrotic and fibrous tissues and inflammatory infiltrates, and the diagnosis was confirmed as an inflammatory pseudotumor of the thymus. The patient’s symptoms were resolved following surgery and the patient remained asymptomatic during the six-month follow-up period. In addition, we reviewed the previous literature and discussed the diagnosis and management of our patient. This report provides further insights into the pathogenesis and underlying mechanisms of inflammatory pseudotumors of the thymus to aid in the diagnosis and development of effective therapies.

Inflammatory pseudotumour of the lung: a case report and literature review

We describe a patient with inflammatory pseudotumour of the lung. He was a young man who presented with haemotysis and the chest X-ray and computerized tomography were indicative of a nonbenign lesion in the right upper lobe. Excision biopsy confirmed the diagnosis of inflammatory myofibroblastic pseudotumour of the lung. This is a rare inflammatory nonneoplastic condition commonly affecting children and young adults.

Inflammatory pseudotumor of the lung with rapid growth

A 58-year-old man presented with a nodule in the right lung. Initially, the chest CT showed a ground-glass shadow. However, the shadow had become a solid nodule one month later. Histological examination revealed it was an inflammatory pseudotumor of the lung and subsequent surgery showed it to be an organizing pneumonia type. This disease is rare and in most cases is considered to be slow growing. Chest CT findings in the early stages have not been reported previously. Therefore, the present case is noteworthy in that we could confirm the CT findings in the early stages of this disease with rapid growth.

Endobronchial inflammatory pseudotumor: a case report

Inflammatory pseudotumor of the lung is a rare form of benign neoplasia and is generally characterized by a solitary pulmonary nodule. The endobronchial presentation is uncommon. Conservative surgery remains the treatment of choice, and surgeons should always strive to achieve tumor-free margins due to the possibility of local recidivism. This article reports the case of a 36-year-old male patient with recurrent attacks of wheezing and cough. The patient underwent successful bronchoplasty for the resection of an endobronchial inflammatory pseudotumor.

Unusual non-neoplastic lesions of the lung

Many nonneoplastic conditions that may affect the lung are in reality rare or unusual manifestations of metabolic processes, inflammatory conditions, or unknown etiology. Because of their rarity, they can often be confused with malignant neoplasms. Familiarity with these conditions not only will expedite further treatment for these patients but also will avoid the process of more tests or unnecessary surgical procedures. The nomenclature for some of those conditions is still controversial. The clinical outcome of these conditions can be quite variable, with some patients surviving a long number of years and others eventually succumbing to the disease. We will limit our discussion in this review to four of these conditions, including inflammatory pseudotumor (inflammatory myofibroblastic tumor), placental transmogrification of lung, alveolar microlithiasis, and metastatic calcification. Although these lesions are not part of the gamut of neoplastic conditions affecting the lung, they are nonetheless important to recognize, as their outcome may not necessarily be an innocuous one.

Resection of the Entire Left Mainstem Bronchus for an Inflammatory Pseudotumor

We present the case of a 16-year-old white girl with a history of recurrent postobstructive pneumonia. Chest roentgenogram, chest computed tomography, and bronchoscopy revealed a mass in the left mainstem bronchus with an exophytic component. Multiple bronchoscopic biopsies confirmed the mass to be an inflammatory pseudotumor. After failing months of medical therapy with systemic steroids as well as several laser ablations, the tumor was removed through a left thoracotomy with resection of the entire left mainstem bronchus and reimplantation of the left upper and lower lobe into the trachea without complication or recurrence after 1 year.

[Intraparenchymal pulmonary inflammatory pseudotumors]

Inflammatory pseudotumors are rare entities which occasionally affect the pulmonary parenchyma. Their clinical diagnosis arises in a variety of ways and half the time they are detected by chance. Deciding on a therapeutic approach is difficult because a firm diagnosis is established only after studying the excised tissue. We describe our experience with the diagnosis, surgical treatment, and follow up of 4 cases of inflammatory pseudotumor located in the pulmonary parenchyma and treated by surgical resection (by thoracotomy or video assisted thoracoscopic surgery) with good outcomes following complete resection.

Benign bronchopulmonary tumors: radiologic and pathologic findings

According to the new World Health Organization classification, benign bronchopulmonary tumors can be classified into epithelial tumors, mesenchymal tumors, and tumor-like conditions. Imaging findings of benign tumors of large airways are nonspecific and overlapping. Some benign pulmonary tumors show characteristic imaging findings. On CT, bronchioloalveolar adenomas appear as a small nodular area of ground-glass opacity. Metastasizing leiomyomas are seen as well-circumscribed solitary or multiple pulmonary nodules ranging in size from a few millimeters to several centimeters. Pulmonary hamartomas or lipomas are recognized specifically when fat deposits of CT number in the -80 HU to -120 HU range are identified. Enhancement of tumor with administration of contrast medium with or without foci of calcification may be seen in sclerosing hemangiomas and hemangiopericytomas. Awareness of the various imaging findings of these tumors can help narrow down the differential diagnosis on daily practice among the long lists of bronchopulmonary tumors.

Involvement of 2p23 in pulmonary inflammatory pseudotumors

Pulmonary inflammatory pseudotumors (IP) are rare mesenchymal proliferations that have a polymorphic histology and an unpredictable biologic behavior. The histologic spectrum of IP has led to uncertainty as to whether this tumor has a reactive or neoplastic pathogenesis. Reports of extrapulmonary IP have identified clonal chromosomal aberrations involving 2p23 in the region of the ALK gene. Using fluorescence in situ hybridization with a probe flanking the ALK gene at 2p23 and immunostaining for the ALK gene product, we studied formalin-fixed, paraffin-embedded tissues of pulmonary IP and found a subset (33%) with 2p23 aberrations. We suggest that chromosomal rearrangements and ALK immunostaining may be helpful in the diagnosis of a group of pulmonary IP and should be investigated as a potential tool for predicting their future biologic behavior. An association with anaplastic large-cell lymphoma was also observed. HUM PATHOL 32:428-433.

Inflammatory pseudotumor: a controversial entity

Inflammatory pseudotumor of the lung is considered to be a rare, benign, neoplastic lesion, consisting mainly of spindle mesenchymal cells, sometimes in such a way that its histological appearance mimics that of a spindle cell sarcoma, fibrous histiocytoma or fibrosarcoma. On the occasion of a case managed in our department, the literature is reviewed, in an attempt to clarify some issues concerning this tumor. Emphasis is given to complete resection of the tumor for both diagnostic and therapeutic purposes. Malignant behavior may occur and recurrence is possible.