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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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3
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Keng LT, Lo WY, Huang HN, Ko HJ, Liang SK. Pulmonary granulomas: give it a whorl. Thorax 2020; 76:954-955. [PMID: 33443232 DOI: 10.1136/thoraxjnl-2020-216506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Li-Ta Keng
- Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Wei-Yung Lo
- Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hsien-Neng Huang
- Pathology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Huan-Jang Ko
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Sheng-Kai Liang
- Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
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5
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Rheumatoid lung nodules with "feeding-vessel" sign. Clin Rheumatol 2020; 40:1645-1647. [PMID: 32827281 DOI: 10.1007/s10067-020-05351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
Rheumatoid arthritis is a systemic inflammatory disease which causes symmetric polyarthritis. Lungs are common site for extra-articular involvement. Rheumatoid lung nodules occur in about 32% of patients with rheumatoid arthritis. The appearance of a lung nodule, along with the blood vessel supplying it, is called "feeding-vessel" sign on computed tomography. It is most commonly seen in infections. However, it can also be present in metastases and pulmonary vasculitis. We describe a woman with long-standing rheumatoid arthritis with subcutaneous and pulmonary nodules. Computed tomography of the chest showed "feeding-vessel" sign. There was no evidence of infection, malignancy, or vasculitis. She was treated for rheumatoid lung nodulosis with rituximab with which she improved remarkably. To the best of our knowledge, "feeding-vessel" sign in rheumatoid lung nodules has never been reported before. This case highlights the fact that "feeding-vessel" sign is not specific for pulmonary infections. It can rarely be seen in rheumatoid lung nodulosis.
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Smelt JLC, Madden B, Du Parcq J, Hunt I. A rare solitary and endobronchial pulmonary hyalinising granuloma requiring bilobectomy. SAGE Open Med Case Rep 2020; 8:2050313X20967175. [PMID: 35154768 PMCID: PMC8826096 DOI: 10.1177/2050313x20967175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/28/2020] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hyalinising granuloma is a very rare disease often presenting as multiple smooth rounded nodules within the lung parenchyma and mimicking metastatic disease. Solitary pulmonary hyalinising granuloma is an even rarer subgroup, and to our knowledge, there have been no endoluminal pulmonary hyalinising granulomas reported. A 36-year-old female non-smoker with no significant past medical history presented with a persistent cough and was found to have a right lower lobe bronchial lesion causing lower lobe obstruction. After multiple failed attempts at tissue diagnosis from both percutaneous and endobronchial biopsies, and with worsening haemoptysis, the patient underwent a right thoracotomy and lower bilobectomy. The histopathology was reported as a solitary endobronchial pulmonary hyalinising granuloma. Although benign in nature, tissue diagnosis can be difficult in these lesions, especially when presenting as a solitary mass in a central location. This report demonstrates that these lesions can also be found endobronchially necessitating parenchymal resection for diagnosis and obstructive symptoms.
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Affiliation(s)
- Jeremy LC Smelt
- Department of Thoracic Surgery, St George’s Hospital NHS Foundation Trust, London, UK
| | - Brendan Madden
- Department of Thoracic Surgery, St George’s Hospital NHS Foundation Trust, London, UK
| | - John Du Parcq
- Department of Histopathology, St George’s Hospital NHS Foundation Trust, London, UK
| | - Ian Hunt
- Department of Thoracic Surgery, St George’s Hospital NHS Foundation Trust, London, UK
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7
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Kamona A, Al Lawati F, Kamona A, Al Busaidi N, Al Mahrooqi Y, Al-Tai S, Al Lawati N, Al-Umairi RS. Pulmonary Hyalinising Granuloma: A report of two cases. Sultan Qaboos Univ Med J 2019; 19:e157-e160. [PMID: 31538016 PMCID: PMC6736260 DOI: 10.18295/squmj.2019.19.02.013] [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: 01/02/2018] [Revised: 03/25/2019] [Accepted: 04/18/2019] [Indexed: 12/01/2022] Open
Abstract
Pulmonary hyalinising granuloma (PHG) is a rare fibrosclerosing inflammatory lung condition of unknown aetiology. It is characterised by solitary or multiple pulmonary nodules that are usually found incidentally while imaging the chest for other reasons. We report two cases of histologically proven PHG diagnosed at the Royal Hospital, Muscat, Oman. The first case was a 71-year-old male patient who presented in 2010 with a dry cough, weight loss and bilateral pulmonary nodules. The second case was a 58-year-old male patient who presented in 2012 and was found to have incidental bilateral pulmonary nodules on chest X-ray. Both patients were started on prednisolone and on follow-up the PHG nodules remained stable. Although there is no definitive treatment, PHG generally has an excellent prognosis.
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Affiliation(s)
- Ameen Kamona
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Atheel Kamona
- Department of Radiology, Royal Hospital, Muscat, Oman
| | | | | | - Saqar Al-Tai
- Department of Radiology, Royal Hospital, Muscat, Oman
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8
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Abstract
We herein report a case of pulmonary hyalinizing granuloma (PHG), which is a rare pulmonary mass. A 69-year-old man with no symptoms presented to our hospital because of the appearance of an abnormal shadow on chest X-ray. Computed tomography revealed a right middle-lobe mass with spicula and infiltration into the upper lobe. Since a bronchofiberscopic examination showed no malignant cells in the specimen, the patient underwent thoracoscopic surgery, which revealed PHG. Spiculation and interlobar infiltration, which comprise the characteristic features of primary lung cancer, are uncommon presentations of this rare entity.
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Affiliation(s)
- Shigeo Kawase
- Department of Respiratory Medicine, Kure Kyosai Hospital, Japan
| | - Rie Matsumoto
- Department of Thoracic Surgery, Kure Kyosai Hospital, Japan
| | - Shigeo Imai
- Department of Thoracic Surgery, Kure Kyosai Hospital, Japan
| | | | - Yusuke Hata
- Department of Respiratory Medicine, Kure Kyosai Hospital, Japan
| | - Naokatsu Horita
- Department of Respiratory Medicine, Kure Kyosai Hospital, Japan
| | - Yutaro Shiota
- Department of Respiratory Medicine, Kure Kyosai Hospital, Japan
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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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