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Inflammatory pseudotumor of lung

Posted Mon, 07/20/2009 - 19:18 by Shweta Bhatt

Images

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Figure 2b

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Clinical History:

54-year-old female who presented with left pleuritic chest pain.

Findings:

Figure 1. Chest radiograph shows a lung mass in the left lung apex. Figure 2. CT of the chest in mediastinal ( a) and lung windows (b) shows a heterogeneous lung mass in the left lung apex. Figure 3. Follow-up CT demonstrates reduced size of the left lung mass with a new mass in the right lung apex. Figure 4. PET-CT demonstrated moderately increased FDG uptake in both the lung lesions. Figure 5. Follow up CT after 4 weeks of conservative therapy including antobiotics and corticosteroids , demonstrates complete resolution of the lung lesions.

Diagnosis:

Inflammatory pseudotumor of the lung

Discussion:

Inflammatory pseudotumor of lung is a rare benign lung tumor of uncertain etiology, occurring more commonly in the younger patients. It represents nonneoplastic unregulated growth of inflammatory cells.It is also known as 'plasma cell granuloma', 'histiocytoma', and 'fibroxanthoma' depending on the predominant cell type. Histologically these tumors are composed of inflammatory cells and show complete maturity of fibroblastic component with striking lack of mitosis. Patients with this entity usually present with cough, chest pain, dyspnoea and haemoptysis. Inflammatory pseudotumors may mimic lung carcinoma and pose diagnostic and therapeutic difficulties both for the clinicians as well as the radiologists (2).The most common radiographic presentation is that of a solitary well-circumscribed round or oval pulmonary mass (1). Some patients may present with ill-defined areas of pneumonic consolidation or atelectesis. Most pseudotumors are seen in the periphery of the lungs as a solitary nodule or a mass. Small ipsilateral effusions can be seen in some. Pathologically, inflammatory pseudotumors demonstrate a mixed inflammatory infiltrate with a preponderance of plasma cells, Complete resection with pulmonary conservation remains the treatment of choice (3). Some inflammatory pseudotumors may also respond to steroids and radiation, but are prone to recurrence, and therefore long term follow up is necessary. The inflammatory pseudotumors are not limited to the lung and can involve other systems such as the kidney , or the spleen.

References / Suggested Reading:

1. Glickstein M, Kornstein MJ, Pietra GG et al: Nonlymphomatous lymphoid disorders of the lung. AJR 1986; 147: 227-237. 2. Mandelbam I, Brashear R, Hull MT. Surgical treatment and course of pulmonary pseudotumor (plasma cell granuloma). J Thorac Cardiovasc Surg. 1981; 82:77 – 82. 3. Kishi K, Fujii T, Kurosaki A, Nakata K, Yoshimura K. Recurrence of inflammatory pseudotumor of the lung after eleven years of remission. Intern Med. 2009;48(12):1079-83.

Author

Shweta Bhatt, MD and Vikram S Dogra, MD

Assistant Professor (SB) and Professor (VSD) of Radiology

University of Rochester , Rochester, NY