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Alhumayed M, Austin RP, Chang EY. Extrapulmonary hyalinizing granuloma: a rare case with intra-articular and tenosynovial involvement. Skeletal Radiol 2024:10.1007/s00256-024-04762-9. [PMID: 39048672 DOI: 10.1007/s00256-024-04762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
Extrapulmonary hyalinizing granuloma (EPHG) is a notably rare condition, representing an exaggerated chronic immune response to antigenic stimuli. This report presents the first documented case of intra-articular and tenosynovial EPHG with radiological evaluation and pathological confirmation in a 60-year-old man presenting with wrist pain and swelling. Imaging findings were relatively symmetric with marked distension of the distal radioulnar joints and extensor tendon sheaths with masses and nodules of various sizes surrounded by synovitis and accompanied by bony erosions. On US, the masses were heterogeneous but mostly hypo- to iso-echoic compared to muscle and relatively hypovascular. On MRI, compared to muscle, the nodules exhibited iso-intense signal on T1-weighted images, iso- to mildly hyper-intense signal on T2-weighted fat-suppressed images, and minimal enhancement on post-contrast images. The diagnosis of EPHG was revealed through biopsy and pathologic examination with glucocorticoids being effective in treatment.
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Affiliation(s)
- Mohanad Alhumayed
- Department of Radiology, University of California San Diego, San Diego, CA, 92103, USA.
| | - Ryan P Austin
- Department of Pathology, Naval Hospital Camp Pendleton, Oceanside, CA, 92055, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, San Diego, CA, 92103, USA
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA
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2
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Soni N, Ora M, Gupta S, Maheshwarappa RP, Priya S, Graham MM. Multimodality imaging in a case of multiple pulmonary hyalinizing granulomas - A decade follow-up. Lung India 2021; 38:477-480. [PMID: 34472528 PMCID: PMC8509177 DOI: 10.4103/lungindia.lungindia_1004_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 44-year-old male was referred to our clinic (2015) to evaluate multiple lung nodules with increasing fatigue, dyspnea, and weight loss. He was being assessed to an outside hospital for the same since 2010. The X-ray and computed-tomography (CT)-chest showed numerous pulmonary nodules and bilateral hilar adenopathy. Imaging workup at our institute (2015) redemonstrated extensive calcified pulmonary nodules. 18fluoro-2-deoxy-d-glucose positron emission tomographyCT showed widespread pulmonary nodules with low-grade uptake. Video-assisted thoracic surgery lung biopsy revealed pulmonary hyalinizing granuloma (PHG). Recently because of increasing symptoms, he is being evaluated for a lung transplant. This case represents a rare diagnosis of PHG with a decade follow-up.
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Affiliation(s)
- Neetu Soni
- Department of Radiology, UIHC, Iowa City, IA, USA
| | - Manish Ora
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sarika Gupta
- Department of Pathology, UIHC, Iowa City, IA, USA
| | | | - Sarv Priya
- Department of Radiology, UIHC, Iowa City, IA, USA
| | - Michael M Graham
- Division of Nuclear Medicine; Department of Radiation Oncology, Iowa City, IA, USA
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Yoo YJ, Sun JS, Lee JH, Jung HJ, Koh YH, Jung J, Kim HG. Atypical Presentation of Chronic Granulomatous Disease in a Neonate with a Pulmonary Granuloma Mimicking a Tumor: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:990-995. [PMID: 36238165 PMCID: PMC9432210 DOI: 10.3348/jksr.2020.81.4.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/15/2019] [Accepted: 10/30/2019] [Indexed: 11/15/2022]
Abstract
Chronic granulomatous disease (CGD) is an uncommon primary immune deficiency caused by phagocytes defective in oxygen metabolite production. It results in recurrent bacterial or fungal infections. Herein, we present a case of CGD with a large pulmonary granuloma in a neonate and review the imaging findings. The patient was a 24-day-old neonate admitted to the hospital with fever. A round opacified lesion was identified on the chest radiograph. Subsequent CT and MRI revealed a round mass with heterogeneous enhancement in the right lower lobe. There were foci of diffusion restriction in the mass. Surgical biopsy of the mass revealed chronic granuloma. Finally, the neonate was diagnosed with CGD caused by mutation of the gp91phox gene. Herein, we present the clinical and imaging findings of this unusual case of CGD.
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Affiliation(s)
- Young Jin Yoo
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Hyun Joo Jung
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Yeong Hwa Koh
- Department of Pathology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Joonho Jung
- Department of Cardiac Surgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Hyun Gi Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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4
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Pulmonary hyalinising granuloma: A rare cause of multiple lung nodules in lung cancer clinic. Respir Med Case Rep 2018; 25:55-57. [PMID: 30003021 PMCID: PMC6039758 DOI: 10.1016/j.rmcr.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 11/20/2022] Open
Abstract
Here we report a case of Pulmonary Hyalinising Granuloma (PHG) presenting with mild to moderate FDG positive nodules in an individual with a high risk of cancer. We explore the considerations in interpreting imaging findings and assess the benefits and risks of undertaking invasive investigations such as tissue biopsy. We highlight the importance of reaching an accurate diagnosis of this benign condition on our patients and their future outlook.
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Lhote R, Haroche J, Duron L, Girard N, Lafourcade MP, Martin M, Begueret H, Taytard A, Capron F, Grenier P, Piette JC, Cohen-Aubart F, Amoura Z. Pulmonary hyalinizing granuloma: a multicenter study of 5 new cases and review of the 135 cases of the literature. Immunol Res 2018; 65:375-385. [PMID: 27561787 DOI: 10.1007/s12026-016-8852-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pulmonary hyalinizing granuloma (PHG) is a rare disease characterized by single or multiple benign lung nodules mimicking lung neoplasma. Histologic analysis reveals homogenous hyaline lamellae, usually surrounded by collection of plasma cells, lymphocytes and histiocytes in a perivascular distribution. The clinical and radiological findings have been described in small series, but the long-term outcomes have rarely been reported. The objectives were to describe the clinical, radiological and outcomes of PHG in new cases and through a literature review. Patients with PHG were found by a multicenter search among French departments of internal medicine, pulmonology and anatomo-pathology. Review of the literature was made through the National Library of Medicine's MEDLINE database using keywords "hyalinizing granuloma." Five news cases and 135 cases of the literature were found. There were 82 men and 57 women, mean age at the diagnosis 44.6 years (15-83). Patients were frequently asymptomatic (n = 39, 27.4 %). The nodule was unique in 37 cases (28.9 %) and multiple in 91 cases (71.1 %). 18FDG PET scan revealed hypermetabolism of the nodule in 9/15 cases (60 %). A systemic disease was associated in 65 cases (mainly mediastinal and retroperitoneal fibrosis, autoimmune, tumoral or infectious disease or thromboembolism). The outcomes were evaluated in 73 patients when follow-up was available: 14 patients had a surgical resection of the nodule. Forty-five patients did not receive any immunosuppressive drug. Among these patients, 2 improved, 29 were stable and 14 worsened. Corticosteroids were used as a monotherapy in 19 patients and led to radiological improvement in 8 cases, stabilization in 8 cases and worsening in 3 cases. Five patients were treated with corticosteroids and at least one immunosuppressive drug and 4 patients improved. PHG is a rare benign disease, mimicking lung neoplasma, frequently associated with systemic diseases.
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Affiliation(s)
- Raphael Lhote
- Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Julien Haroche
- Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.,Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France
| | - Loïc Duron
- Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Nicolas Girard
- Service de Pneumologie, Centre National de Référence des Maladies Pulmonaires Rares Centre Expert National associé du Réseau RYTHMIC Tumeurs Thymiques et Cancer, Hôpital Louis Pradel, Lyon, France
| | | | - Michel Martin
- Service de Pneumologie, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Hugues Begueret
- Service d'Anatomo-Pathologie, Centre Hospitalier de Pessac, Pessac, France
| | - André Taytard
- Service de Pneumologie, Centre Hospitalier de Pessac, Pessac, France
| | - Frédérique Capron
- Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France.,Service d'Anatomo-pathologie, AP-HP, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Philippe Grenier
- Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France.,Service de Radiologie, AP-HP, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Jean Charles Piette
- Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.,Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France
| | - Fleur Cohen-Aubart
- Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. .,Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France.
| | - Zahir Amoura
- Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.,Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France
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Gooty V, Harris C, Muelenaer A, Watson B, Safford SD. A rare case of pulmonary hyalinizing granuloma with calcification in a 5 year old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Egnatios J, Chao C, Naheedy J. An idiopathic case of pediatric retroperitoneal fibrosis with extensive magnetic resonance imaging and follow-up. Pediatr Radiol 2014; 44:1323-7. [PMID: 24756251 DOI: 10.1007/s00247-014-2976-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 02/04/2014] [Accepted: 03/12/2014] [Indexed: 11/29/2022]
Abstract
Retroperitoneal fibrosis has seldom been described in the pediatric literature. We present a child who presented with retroperitoneal fibrosis without any associated underlying vascular or inflammatory conditions. This is one of only a few cases of primary idiopathic retroperitoneal fibrosis in a pediatric patient to have been imaged extensively by MRI.
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Affiliation(s)
- Jeremy Egnatios
- School of Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA,
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Dinand V, Bakhshi S, Jain S, Dhawan S, Yadav SP, Sachdeva A. Clinicopathological conference: a 9-y-old girl with transient chest pain. Indian J Pediatr 2013; 80:391-6. [PMID: 23275186 DOI: 10.1007/s12098-012-0942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Affiliation(s)
- V Dinand
- Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi 110 060, India
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A Unique Case of Pulmonary Hyalinizing Granuloma Associated With FDG-avid PET Scan and Deep Venous Thrombosis. J Bronchology Interv Pulmonol 2012; 16:108-11. [PMID: 23168510 DOI: 10.1097/lbr.0b013e31819b51db] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An 83-year-old obese woman with a 60-pack-year smoking history was referred for evaluation of an abnormal chest radiograph [chest x-ray (CXR)]. Her past medical history was significant for recurrent deep venous thrombosis without any predisposing factors. CXR showed a large mass in the right mid lung and another nodule at the right apex, highly suspicious for a neoplastic process. These were not present on a CXR from 2 years earlier. An fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scan revealed that all lesions were strongly FDG-avid. Six CT-guided core-needle lung biopsy specimens were obtained from the lung mass and all contained dense, lamellar, or "ropy" keloid-like collagen bundles arranged in a haphazard pattern. The biopsy specimens lacked significant necrosis and granulomas. Congo red stain with polarization was also negative for amyloid. The diagnosis of pulmonary hyalinizing granuloma (PHG) was made. A complete hypercoagulable workup was performed but no underlying abnormalities were found, including a negative lupus anticoagulant and malignancy workup. The patient was maintained on warfarin and followed with serial CT scans for 1 year, with spontaneous regression in the lung mass. The case is unique as it is the first case that reports an association of PHG with recurrent deep venous thrombosis in the absence of autoimmune or procoagulant factors and emphasizes the need for life-long anticoagulation in such scenarios. Also, we report the FDG-avid PET scan findings here that are novel for this disease in adults and add PHG to the list of diseases causing false-positive PET scans when malignancy is suspected.
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Chapman EM, Gown A, Mazziotta R, Churg A. Pulmonary Hyalinizing Granuloma With Associated Elevation in Serum and Tissue IgG4 Occurring in a Patient With a History of Sarcoidosis. Am J Surg Pathol 2012; 36:774-8. [DOI: 10.1097/pas.0b013e318248713d] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Hyalinizing granuloma: an unusual case of a pulmonary mass. Case Rep Med 2010; 2010:984765. [PMID: 20592998 PMCID: PMC2892707 DOI: 10.1155/2010/984765] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 05/07/2010] [Indexed: 11/28/2022] Open
Abstract
We describe the case of pulmonary hyalinizing granuloma in a 34-year-old asymptomatic man who presented with a pulmonary nodule apparent by chest radiography and computed tomography (CT). He had a history of previous treatment for tuberculosis. His laboratory data were normal. Bronchoscopy and CT-guided percutaneous transthoracic fine needle aspiration cytology were inconclusive. The diagnosis was revealed after the histopathological examination of an open lung biopsy.
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Jansen I, Hendriksz TR, Han SH, Huiskes AWLC, van Bommel EFH. (18)F-fluorodeoxyglucose position emission tomography (FDG-PET) for monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Eur J Intern Med 2010; 21:216-21. [PMID: 20493425 DOI: 10.1016/j.ejim.2010.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/05/2010] [Accepted: 02/22/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the value of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in monitoring disease activity and predicting treatment response in idiopathic retroperitoneal fibrosis (iRPF). PATIENTS AND METHODS This prospective study was approved by the institutional review board. Informed consent was obtained from all patients. Twenty-six patients with iRPF receiving tamoxifen monotherapy underwent repeated FDG-PET (baseline and, if positive, at 3 months) and computed tomographic (CT) scanning (baseline, 4 and 8 months). Maximal RPF mass thickness in 3 different view directions was measured on each CT scan; FDG-uptake was semi-quantified using a visual 4-point scale. Initial and follow-up PET scan results were correlated with clinical, laboratory and CT scan follow-up data. Treatment outcome was the aggregate measure of clinical, laboratory and CT-documented response to tamoxifen. RESULTS FDG-PET was positive in 20 patients. Patients with positive PET scan result had higher C-reactive protein level (P=0.02) and larger mass size (P=0.01) compared with patients with negative PET scan result. Visual PET score correlated with C-reactive protein level (P=0.002) and CT-documented mass thickness (P=0.04). Visual PET score decreased following treatment (P<0.01). This decrease correlated with decrease in ESR (P<0.001) but not with CT-documented mass regression. Positive predicting value (PPV) of initial positive PET scan result was 0.63; PPV of negative follow-up PET scan result in patients with initial positive PET scan result was 0.66. CONCLUSION FDG-PET is valuable in detecting (recurrent) disease activity. Short-term follow-up with FDG-PET cannot be routinely recommended for the therapeutic evaluation of RPF disease in tamoxifen-treated patients.
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Affiliation(s)
- I Jansen
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Preuss J, Woenckhaus C, Thierauf A, Strehler M, Madea B. Non-diagnosed pulmonary hyalinizing granuloma (PHG) as a cause of sudden unexpected death. Forensic Sci Int 2008; 179:e51-5. [PMID: 18621495 DOI: 10.1016/j.forsciint.2008.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 02/15/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
Abstract
Pulmonary hyalinizing granuloma (PHG), a very rare benign tumour of the lungs, was first reported in 1977. We present a PHG of a 32-year-old woman from Yemen who collapsed 1 day after her arrival in Germany. Tuberculosis was suspected and the health authorities nearly closed part of one of the major international airports in Europe. However, this drastic measure was avoided by autopsy and a correct interpretation of the solid-elastic and well-circumscribed lung tumour as not characteristic for tuberculosis. Although the final diagnosis of PHG was only achieved after histology, this case strongly illustrates the necessity of a profound morphological training of forensic physicians.
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Affiliation(s)
- J Preuss
- Department of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
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Winger DI, Spiegler P, Trow TK, Goyal A, Yu H, Yung E, Katz DS. Radiology–Pathology Conference: pulmonary hyalinizing granuloma associated with lupus-like anticoagulant and Morvan's Syndrome. Clin Imaging 2007; 31:264-8. [PMID: 17599621 DOI: 10.1016/j.clinimag.2007.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 03/26/2007] [Indexed: 11/30/2022]
Abstract
Pulmonary hyalinizing granulomata are rare, noninfectious, fibrosing lesions of the lung, which can mimic metastatic disease radiographically. Their etiology is unknown, but they may be caused by an exaggerated immune response. We report the radiology, long clinical course, and pathology of a patient with pulmonary hyalinizing granuloma who presented with initially asymptomatic pulmonary nodules. Over a 10-year period, the patient developed multiple insidious autoimmune phenomena, including lupus anticoagulant, neuromyotonia, demyelinating sensorimotor polyneuropathy, and eventually, Morvan's syndrome. Such an association has not been previously published to our knowledge.
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Affiliation(s)
- David I Winger
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, 11501, USA
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