Unusual non-neoplastic lesions of the lung

Operated pulmonary inflammatory myofibroblastic tumors: Our experience with 17 cases

Background

In this study, we aimed to evaluate the clinicopathological features of pulmonary inflammatory myofibroblastic tumor cases operated in our clinic.

Methods

A total of 17 inflammatory myofibroblastic tumor patients (5 males, 12 females; median age: 46 years) who were operated in our clinic between February 2000 and July 2019 were included. Data including sex, age, symptoms, accompanying diseases, tumor localization, tumor diameter, endobronchial extension, maximum standard uptake value of the tumors, surgery type, recurrence, and survival data were analyzed.

Results

Two patients were diagnosed preoperatively and two patients were diagnosed during surgery using frozen-section method before resection. Three (17.7%) patients underwent pneumonectomy, five (29.4%) patients lobectomy, three (17.7%) patients segmentectomy, five (29.4%) patients wedge resection, and one (5.8%) patient bronchial sleeve resection. All patients had complete resection with negative margins. None of them had lymph node metastasis. Median follow-up was 122 (range, 8 to 245 months) months. None of the patients received adjuvant therapy, there was no tumor recurrence or tumor-related death.

Conclusion

It is difficult to make a preoperative diagnosis of inflammatory myofibroblastic tumor patients. Systematic lymph node dissection is not required in diagnosed patients. Complete resection is the most important prognostic factor, and it is critical to achieve this with the smallest resection possible.

The calcified lung nodule: What does it mean?

The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules (PN) to aid diagnosis and to discuss the differential diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, hamartoma, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging.