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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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Yamauchi M, Kamejima S, Yamamoto I, Ohkido I, Araya J, Yokoo T. A case of pulmonary hyalinizing granuloma characterized by pseudohyponatremia due to hyperproteinemia. Respir Med Case Rep 2023; 43:101854. [PMID: 37124054 PMCID: PMC10131122 DOI: 10.1016/j.rmcr.2023.101854] [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] [Received: 12/06/2022] [Revised: 03/11/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] Open
Abstract
A 57-year-old man presented with multiple pulmonary nodules. Thoracoscopic lung biopsy led to a pathological diagnosis of pulmonary hyalinizing granuloma (PHG) at the age of 39 years. The disease was progressive, refractory to therapy, and necessitated home oxygen therapy 10 years after the diagnosis. Hyponatremia progressed gradually along with lung disease. His serum sodium level was 129 mEq/L but serum osmolality was normal (287 mOsm/kg). Concomitant hyperproteinemia (12.1 g/dL) was attributable to hyperglobulinemia. Direct ion-selective electrode measurement revealed a normal sodium level (137 mmol/L). We herein report a case of PHG characterized by pseudohyponatremia due to hyperproteinemia, an uncommon finding in this rare entity. A left lung transplant was successfully performed, and no pseudohyponatremia was observed. Pseudohyponatremia should be suspected and diagnosed to prevent a misdiagnosis that could lead to complications from inappropriate treatment with sodium supplementation or restriction of drinking water. The direct ion-selective electrode measurement was useful for diagnosing pseudohyponatremia.
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Affiliation(s)
- Mariko Yamauchi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Sahoko Kamejima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
- Corresponding author. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, Japan.
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ichiro Ohkido
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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3
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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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4
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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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5
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Wang ST, Wang QP, Li J, Zhang T, Zhang L, Mao YY. Amyloidosis secondary to intrapulmonary Castleman disease mimicking pulmonary hyalinizing granuloma-like clinical features: A rare case report. Medicine (Baltimore) 2019; 98:e15039. [PMID: 30946344 PMCID: PMC6456117 DOI: 10.1097/md.0000000000015039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Amyloidosis secondary to intrapulmonary Castleman disease (CD) is a rare benign disease diagnosed by histopathology. It seems to be associated with chronic inflammation, and large amounts of IL-6 produced in the germinal center of CD may enhance the production of precursor of amyloid. PATIENT CONCERNS We reported a case of an 18-year-old woman presenting with dry cough and dyspnea on exertion for 6 months and detailed exams revealed multiple pulmonary nodules, positive antinuclear antibodies, hypocomplementemia, and thrombocytopenia. DIAGNOSES A computed tomography-guided percutaneous lung biopsy revealed the histopathological features of pulmonary hyalinizing granuloma (PHG), but video-assisted pulmonary wedge resection for biopsy with immunohistochemical stains finally demonstrated a corrected diagnosis of intrapulmonary CD with secondary amyloidosis. INTERVENTIONS The patient had received prednisone and Tacrolimus for 6 months. OUTCOMES There was no significant improvement in pulmonary lesions or platelet level. Chemotherapy to CD was needed. LESSONS Intrapulmonary CD should be considered in patients with multiple pulmonary nodules irresponsive to corticosteroid and diagnosis of PHG should be carefully considered based on small lung biopsy sample. The treatment of amyloidosis secondary to CD remains to be uncertain.
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Affiliation(s)
| | | | | | | | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yue-Ying Mao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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6
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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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7
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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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8
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Ahn JH, Kim JS, Choi JH, Chung JH. A first case report of pulmonary hyalinizing granuloma associated with immunoglobulin A nephropathy. Medicine (Baltimore) 2017; 96:e9088. [PMID: 29245330 PMCID: PMC5728945 DOI: 10.1097/md.0000000000009088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Pulmonary hyalinizing granuloma (PHG) is a rare benign disease that has been shown to be associated with the deposition of immune complexes in the lung parenchyma caused by infection or autoimmune diseases. There have been no reports of PHG in association with immunoglobulin A nephropathy (IgAN). PATIENT CONCERNS A 30-year-old woman visited with a 12-month history of dyspnea on exertion and cough that had worsened 1 month before her visit. DIAGNOSIS PHG associated with IgAN. INTERVENTIONS Steroid pulse therapy was performed. OUTCOMES The patient was discharged uneventfully. LESSONS We present a case of PHG presenting as multiple pulmonary nodules mimicking metastatic lung cancer, which was diagnosed using wedge resection of the right middle lobe through video-assisted thoracoscopic surgery.
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Affiliation(s)
- June Hong Ahn
- Department of Internal Medicine, Regional Center for Respiratory Disease, Yeungnam University Medical Center
| | - Jee Seon Kim
- Department of Internal Medicine, Regional Center for Respiratory Disease, Yeungnam University Medical Center
| | - Joon Hyuk Choi
- Department of Pathology, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jin Hong Chung
- Department of Internal Medicine, Regional Center for Respiratory Disease, Yeungnam University Medical Center
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9
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Pulmonary Hyalinizing Granuloma Mimicking Metastatic Lung Cancer. Case Rep Pulmonol 2015; 2015:610417. [PMID: 26347384 PMCID: PMC4540980 DOI: 10.1155/2015/610417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 07/21/2015] [Indexed: 11/29/2022] Open
Abstract
Pulmonary hyalinizing granuloma is a very rare benign condition, which usually manifests as solitary and sometimes as multiple pulmonary nodules. Deposition of immune complexes in the lung parenchyma due to hypersensitivity reactions is implicated in the etiology of pulmonary hyalinizing granuloma. A 59-year-old female patient who presented to our clinic with complaints of chest pain and cough had bilateral, multiple, and rounded lesions with regular margins suggesting metastatic lung disease. A transthoracic needle biopsy of the nodule was performed in the left pulmonary anterior segment. Biopsy showed no malignancy. Since no diagnosis was made by the biopsy, the patient underwent a video-assisted thoracic surgery. The wedge biopsy reported pulmonary hyalinizing granuloma. We aimed to present the diagnosis and treatment stages of our patient who was diagnosed with pulmonary hyalinizing granuloma in the light of literature review.
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10
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Ussavarungsi K, Khoor A, Jolles HI, Mira-Avendano I. A 40-year-old woman with multiple pulmonary nodules. Pulmonary hyalinizing granuloma. Chest 2015; 146:e198-e203. [PMID: 25451362 DOI: 10.1378/chest.14-0796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 40-year-old woman (a nonsmoker) with history of idiopathic thrombocytopenic purpura and a platelet count > 90,000 cells/μL without specific medication was referred to pulmonary clinic for evaluation of multiple pulmonary nodules. The patient presented to an outside hospital with fatigue, lack of energy, and dyspnea on exertion for 2 years. She denied fever, cough, chest pain, or weight loss. An initial chest radiograph showed bilateral multiple pulmonary nodules. A chest CT scan revealed multiple nodular lesions, varying in size, in all lobes of both lungs. There was no mediastinal lymphadenopathy or pleural effusion. There was no significant hypermetabolic activity on a subsequent fluorodeoxyglucose PET scan/CT scan, and there had been no significant change. She underwent CT scan-guided percutaneous transthoracic biopsy and bronchoscopy with transbronchial biopsies, all of which were inconclusive. An open lung biopsy was considered.
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Affiliation(s)
| | - Andras Khoor
- Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
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11
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Zhou J, Li X, Zeng Q. IgG4-related lung disease with atypical CT imaging: a case report. J Thorac Dis 2015; 6:E276-80. [PMID: 25590008 DOI: 10.3978/j.issn.2072-1439.2014.12.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/29/2014] [Indexed: 12/24/2022]
Abstract
IgG4-related lung disease is a rare disease, diagnosed when typical pathologic features are seen in the context of increased serum levels of IgG4 and the elevated tissue's IgG4-positive plasma cells. Here we reported the case of a 24-year-old woman with IgG4-related lung disease. This patient presented with fever, cough and shortness of breath. Thoracic computed tomography (CT) images demonstrated multiple nodules or masses with high density in both lungs, and thickened interlobular septa. The 'halo sign' was observed around the high-density lesions of the upper lobes. This range of CT images' characteristics is atypical, which differs from previous reports of this condition.
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Affiliation(s)
- Jiaxuan Zhou
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xian Li
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Qingsi Zeng
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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12
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Rodríguez-Muguruza S, Holgado S, Olivé A. Pulmonary hyalinizing granuloma associated with Sjögren syndrome and ANCA MPO vasculitis. Joint Bone Spine 2015; 82:71-2. [DOI: 10.1016/j.jbspin.2014.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
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13
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Matsuoka K, Imanishi N, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Pulmonary hyalinizing granuloma detected in a family member after confirmation of tuberculosis in his father. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:632-4. [PMID: 23903707 DOI: 10.5761/atcs.cr.13-00076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary hyalinizing granuloma (PHG) is an uncommon lung disease that usually presents as bilateral multiple nodules, and more rarely as a solitary nodule. An exaggerated immune response to antigenic stimuli resulting from infection or an autoimmune process has been suggested as the cause of PHG. Here, we describe a rare case of solitary PHG that was detected in a family member after tuberculosis had been confirmed in his father, without any background of infectious disease or autoimmune abnormality.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
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14
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Arruda GDS, Carvalho PCRD, Andrade MPGD, Cusmanich MC, Bandeira G, Tozaki FSP. Recurrent pulmonary hyalinizing granuloma. J Bras Pneumol 2011; 36:662-5. [PMID: 21085833 DOI: 10.1590/s1806-37132010000500019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 06/02/2010] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 61-year-old male patient who underwent surgical excision of a lung mass for anatomopathological study. The patient had previously presented with fever, dry cough, and chest pain, together with lung masses detected by chest X-ray, and had undergone thoracotomy for diagnostic investigation on two occasions (1976 and 1981), although a conclusive diagnosis had not been made. A CT scan of the chest revealed large masses with areas of calcification in both lung fields. The anatomopathological study was consistent with pulmonary hyalinizing granuloma. In the postoperative period, the patient experienced several episodes of bronchospasm, which was reversible with the use of symptomatic medication. At this writing, the patient was receiving maintenance therapy with prednisone (40 mg/day) and had shown clinical improvement.
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Affiliation(s)
- Guilherme D'Andréa Saba Arruda
- Dr. José de Carvalho Florence Municipal Hospital, São Paulo State Association for Development of Medicine/ Federal University of São Paulo – São José dos Campos, Brazil.
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15
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Pulmonary hyalinizing granuloma in HIV/AIDS. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 18:305-7. [PMID: 18923729 DOI: 10.1155/2007/208140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 07/18/2007] [Indexed: 11/17/2022]
Abstract
A 55-year-old man who was recently diagnosed with HIV/AIDS developed multiple bilateral pulmonary nodules after starting highly active antiretroviral therapy. Workup confirmed the diagnosis of pulmonary hyalinizing granuloma. This is the first described case of pulmonary hyalinizing granuloma in HIV/AIDS, and may represent a rare form of immune reconstitution inflammatory syndrome.
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16
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Pulmonary hyalinizing granuloma mimicking multiple lung metastases: report of fluorodeoxyglucose positron emission findings. J Thorac Imaging 2010; 25:W36-9. [PMID: 20351580 DOI: 10.1097/rti.0b013e3181a4bb41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary hyalinizing granuloma (PHG) is a rare disease characterized by multiple bilateral pulmonary nodules of uncertain etiology. We describe a 71-year-old female patient with thyroid papillary carcinoma in whom bilateral pulmonary nodules were found during a routine chest radiography examination. Subsequent fluorodeoxyglucose positron emission tomography/computed tomography scan gave the impression of multiple pulmonary metastases based on high maximum standardized uptake value. She underwent video-assisted thoracoscopic surgery with wedge resection, and PHG was diagnosed on the basis of histopathologic findings. To our knowledge, this is the first report of PHG developing in a patient as a solid cancer, mimicking multiple pulmonary metastases. We also present the first description of positron emission tomography in PHG, according to a Medline search.
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17
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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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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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Ben Ghorbel I, Ennaifer R, Haouet S, Khanfir M, Lamloum M, Miled M, Houman MH. [Pulmonary hyalinizing granuloma revealed by a pituitary gland diffusion]. Rev Med Interne 2007; 29:54-7. [PMID: 18045750 DOI: 10.1016/j.revmed.2007.09.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 09/16/2007] [Accepted: 09/25/2007] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pulmonary hyalinizing granuloma is a rare fibrosing lesion of the lung, characterized by its histological appearance which includes central whorled deposits of lamellar collagen. The extrapulmonary diffusion of the disease is extremely rare, and in our knowledge any case of pituitary diffusion has ever been reported in the literature. EXEGESIS We reported an unpublished case of a 31-year-old woman presenting with amenorrhea, galactorrhea, diplopia, headache, polyuria and polydipsia. The diagnosis of pulmonary hyalinizing granuloma revealed by an intracranial localization was based on radiologic and pathologic findings. Clinical course was favourable with corticotherapy. CONCLUSION Our report is particular because cerebral localization was the initial manifestation of primary hyalinizing granuloma and because of the favourable outcome with corticotherapy.
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Affiliation(s)
- I Ben Ghorbel
- Service de médecine interne, hôpital La-Rabta, 1007 Tunis, Tunisia.
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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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Young AS, Binkovitz LA, Adler BH, Nicol KK, Rennebohm RM. Pulmonary hyalinizing granuloma and retroperitoneal fibrosis in an adolescent. Pediatr Radiol 2007; 37:91-5. [PMID: 17061085 DOI: 10.1007/s00247-006-0340-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 09/12/2006] [Accepted: 09/15/2006] [Indexed: 10/24/2022]
Abstract
We describe a 15-year-old boy who developed pulmonary hyalinizing granuloma (PHG) and retroperitoneal fibrosis (RPF). His PHG and RPF were not associated with histoplasmosis or tuberculosis and appeared to represent idiopathic autoimmune phenomena. This is the first reported case of PHG in a pediatric patient and the fourth reported co-occurrence of PHG and RPF. The use of F-18 fluorodeoxyglucose positron emission tomography in the diagnostic and follow-up evaluation of PHG is reported.
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Affiliation(s)
- Adam S Young
- Children's Radiological Institute, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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Lvovsky D, Rosman J, Iliescu ME. Pulmonary Hyalinizing Granuloma (PHG) Presenting as Bilateral Dense Apical Masses. Chest 2004. [DOI: 10.1378/chest.126.4_meetingabstracts.950s] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Esme H, Ermis SS, Fidan F, Unlu M, Dilek FH. A Case of Pulmonary Hyalinizing Granuloma Associated with Posterior Uveitis. TOHOKU J EXP MED 2004; 204:93-7. [PMID: 15329468 DOI: 10.1620/tjem.204.93] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 48-year-old male was admitted to our hospital because of abnormal pulmonary shadows and a decrease in visual acuity. He had a history of tuberculosis 20 years ago. The chest roentgenogram showed multiple pulmonary nodules throughout both lung fields. No definitive diagnosis was established either by brushing cytology or biopsy through bronchoscopy or percutaneous needle biopsy. Pathological examination of open lung biopsy specimen revealed that extensive, hyalinized lamellar collagen bundles arranged in whorls, parallel arrays. Plasma cells and lymphocytes were found between the collagen bands and germinal centers were seen at the periphery of the lesion. A definitive diagnosis of pulmonary hyalinizing granuloma was made on the basis of these histopathological findings. Although there is no established treatment for pulmonary hyalinizing granuloma, during 1 month of follow-up, posterior uveitis mildly resolved with glucocorticoid treatment and there had been a slight increase in visual acuity.
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Affiliation(s)
- Hidir Esme
- Department of Thoracic Surgery, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey.
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