Clinical and pathological characteristics of patients with pulmonary inflammatory pseudotumors: An 18-year retrospective study of 31 cases

To investigate the clinical and pathological characteristics in patients with pulmonary inflammatory pseudotumors (PIP).This retrospective study included 31 patients with PIP from 2001 to 2019. Preoperative computed tomography scan was performed in all patients. Clinical and pathological characteristics were collected and analyzed.Thirty-one patients (16 female and 15 male) were recruited, with a median age of 57 years (range, 11-72 years). Eight (25.8%) patients were asymptomatic, and the others had symptoms characterized by cough with sputum, chest and back pain, dry cough, fever and blood in sputum, or hemoptysis. All cases were single lesions, including 23 cases in the right lung, and 8 cases in the left lung. Computed tomography scan demonstrated irregular lobulated nodules or masses in 14 patients, and regular round or oval nodules or masses in 11 cases. The blurred edge of tumors and spiculation was found in 12 cases. Microscopic results were characterized by the collection of inflammatory mesenchymal cells. Immunohistochemical examination showed vimentin, smooth muscle actin, and anaplastic lymphoma kinase positive. Complete tumor resection was obtained in all cases. No recurrence or metastasis was observed during the follow-up period.PIP has a variety of manifestations. Preoperative diagnosis is difficult to reach. The final diagnosis still depends on the pathological and immunohistochemical examination. Complete surgical resection is the main treatment at present, and the overall prognosis is good.

Frank Stinchfield Award: Identification of the At-risk Genotype for Development of Pseudotumors Around Metal-on-metal THAs

BACKGROUND

Once touted as the future of hip arthroplasty, metal-on-metal (MoM) bearing surfaces have fallen sharply from favor with the emergence of a strong body of evidence demonstrating unacceptably high premature implant failure rates. The previously unpredictable development of adverse local tissue reactions (ALTRs) has been a substantive contributor to this. Although the underlying pathophysiology of these so-called "pseudotumors" is now well understood, the fundamental predisposing patient risk factors have remained elusive.

QUESTIONS/PURPOSES

The aim of this research, as a clinical-genotype correlation analysis, was to identify specific alleles (genes) associated with the development of ALTRs in patients with in situ MoM THAs.

METHODS

A case-control study of patients who received a large-head, primary MoM THA between 2005 and 2008 was performed with a minimum followup of 5 years. Twenty-six patients who had undergone revision of a primary MoM THA secondary to symptomatic ALTRs were recruited. The mean timeframe from primary MoM THA to symptomatic revision was 5.5 years (range, 1-10 years). Twenty-eight control subjects were randomly selected asymptomatic patients with no evidence of ALTRs on protocol-specific screening. Baseline demographics and high-resolution genotype (human leukocyte antigen [HLA] Class II) were collected for all patients. Cohorts were similar with respect to age at the time of primary MoM THA (mean, 54.8 versus 54.9 years, p = 0.95) and serum cobalt (mean, 5.5 versus 8.5 μg/L, p = 0.09) and chromium concentrations (mean, 2.9 versus 4.2 μg/L, p = 0.27). The association between genotype and revision surgery secondary to ALTRs was determined with gender as a covariate.

RESULTS

The prevalence of the risk genotype was 30% (16 of 54) among the entire cohort. Adjusting for sex, the odds of revision were 6.1 times greater among patients with the risk genotype present than among patients without (95% confidence interval [CI], 1.5-25.4; p = 0.01). Among females, the specificity of the risk genotype was 1.0 (95% CIexact, 0.5-1.0; pexact = 0.03), and for males, it was 0.8 (95% CIexact, 0.6-0.9; pexact < 0.01).

CONCLUSIONS

The findings of this study suggest that, among patients with a primary MoM THA, allelic variation within the HLA Class II loci may be a strong, independent risk factor associated with the need for subsequent revision surgery secondary to pseudotumor formation.

CLINICAL RELEVANCE

Given the hypothesis-generating nature of this novel undertaking, confirmatory prospective clinical studies are required to further elucidate this correlation and to explore the clinical utility of targeted genetic screening in this specific population. This research may, however, represent a key missing piece in the puzzle that is metal ion-induced pseudotumor formation.

Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain

PURPOSE

Recently, concerns have arisen about metal-on-metal (MoM) total hip arthroplasty (THA). Therefore, the purpose of this cross-sectional cohort study was to describe the incidence of pain, pseudotumours, revisions and the relation between elevated metal ion levels, functional outcome and quality of life after MoM THA.

METHODS

In 351 patients, 377 MoM THA with a fixed-size 38-mm head were evaluated with a mean follow-up of 30 months (range 11-58). Evaluation included pain, serum metal ions, patient-reported questionnaires (Short Form-36 [SF-36], Hip disability and Osteoarthritis Outcome Score [HOOS] and the Oxford Hip Score [OHS]) and radiological imaging. Sixteen patients did not participate in the screening.

RESULTS

One hundred and eighteen (35 %) patients reported pain and showed significantly higher cobalt and chromium levels compared to patients without pain. Median serum cobalt levels were 4.4 μg/l (interquartile range [IQR] 6.6) and chromium levels were 3.6 μg/l (IQR 4.8). Patients with cobalt levels of ≤5 μg/l reported significantly better outcome on the SF-36 and HOOS. Fifty-seven pseudotumours were identified in 227 THAs. A revision rate of 19 % was observed.

CONCLUSIONS

In conclusion, 35 % of the patients experienced pain after MoM THA. These patients showed significantly higher serum metal ion levels. The patient-reported questionnaires indicated significantly better outcome in patients with cobalt levels ≤5 μg/l.

[Intrathoracic-mediastinal myofibroblastic tumor. Report and experience of one case]

BACKGROUND

Inflammatory pseudotumor is a little known and uncommon condition. The debate continues whether it represents an inflammatory lesion or is a true neoplasm. It is considered a reactive process usually characterized by irregular growth of inflammatory cells. It has been described at various sites, the most common being the lung. The aim of this report is to emphasize the difficulty in the initial diagnosis.

CLINICAL CASE

We present the case of a 56-year-old male who reports an 8-month history of dry cough, dyspnea, fatigue, weakness and weight loss of 20 kg. We performed two biopsies, one positive for malignancy without response to medical treatment and the second reporting chronic granulomatous inflammation. The patient underwent sternotomy, revealing a tumor of 20 × 17 × 10 cm, weighing approximately 2 kg. The tumor was dependent on the anterior mediastinum surrounding large vessels, and venous brachiocephalic, pericardium and both pleuras with firm adhesions to the right lung. Pathological report was as follows: inflammatory myofibroblastic tumor with positive immunohistochemistry for CD20 and CD3. Postoperative course was satisfactory and 1 year after surgery there was no evidence of recurrence.

CONCLUSION

Inflammatory pseudotumor is a benign neoplasm of unknown origin with a chronic course. It can simulate a malignant tumor, causing constitutional manifestations, airway obstruction, cardiac alterations or other symptoms according to their location. Diagnosis is based on radiological features and direct biopsy. Treatment of choice is complete resection of the tumor with a favorable long-term outcome.

Eyelid tumours and pseudotumours in Hong Kong: a ten-year experience

OBJECTIVE

To describe the clinicopathological characteristics of patients with eyelid tumours in Hong Kong.

DESIGN

Retrospective case series.

SETTING

A tertiary eye centre in Hong Kong.

PATIENTS

A computerised retrieval system was used to identify all patients who underwent eyelid mass excisions with histological reports, encountered in the period 2000 to 2009, in a tertiary eye centre. The demographics (age, gender), clinical features (laterality, tumour topography), and the pathological diagnosis of each patient were documented. Descriptive statistical tabulation and analyses were performed on the data.

RESULTS

In all, 198 patients were identified; all were Chinese. Their mean age was 54 years for benign lesions and 68 years for malignant ones. Women were more commonly affected. Benign tumourous lesions occurred more commonly on the upper (n=91; 54%) than lower eyelid (n=79; 47%), whereas malignant lesions more often affected the lower (n=17, 61%) than upper (n=11, 39%) eyelid. The distribution of left and right eye involvement was similar (103 vs 101, respectively). In six patients, there were bilateral benign lesion. Regarding benign masses, 45 (27%) were intradermal neavi, 38 (22%) were squamous papillomas, 25 (15%) were seborrhoeic keratosis lesions, 14 (8%) were epidermoid cysts, and 7 (4%) were compound naevi. Regarding malignant eyelid tumours, the most common was basal cell carcinomas (n=12, 43%), 5 (18%) were squamous cell carcinomas, 3 (11%) were actinic keratosis lesions, and 2 (7%) each were sebaceous gland carcinomas and melanomas.

CONCLUSION

Benign lesions constituted the majority of these eyelid tumours. Among the malignant lesions, basal cell carcinoma was the commonest type, with lower lid involvement in majority. Sebaceous gland carcinoma is not rare, which is in contrast to Caucasian populations. The relative frequencies of the most common malignant tumours in Hong Kong differed substantially from those reported in other Asian studies.

IgG4-related tubulointerstitial nephritis and hepatic inflammatory pseudotumor without hypocomplementemia

Immunoglobulin G4 (IgG4)-related tubulointerstitial nephritis (TIN) is often accompanied by autoimmune pancreatitis (AIP) or chronic sclerosing dacryoadenitis and sialoadenitis. However, IgG4-related TIN without AIP or lacrimal and/or salivary gland lesions has not been well recognized. Here, we report a case of IgG4-related TIN associated with hepatic inflammatory pseudotumor without AIP or lacrimal and/or salivary gland lesions. A 58-year-old Japanese man with epigastralgia underwent contrast-enhanced computed tomography (CT), which revealed multiple low-density lesions in both kidneys and a low density hepatic mass. Laboratory tests showed an extremely high level of serum IgG4. Percutaneous renal and hepatic biopsies showed diffuse infiltration of lymphocytes and IgG4-positive plasma cells with fibrosis in both tissues. Two months after administration of oral prednisolone, both lesions decreased in size on follow-up CT, and the serum creatinine level also improved. No recurrence has been detected for two years with a maintenance dose of prednisolone.

Plasma Cell Granuloma of the Thyroid and Hashimoto Thyroiditis

Plasma cell granuloma of the thyroid is a rare tumor-like lesion formed by a localized proliferation of inflammatory cells, supported by a stroma of fibrous tissue. Few cases have been previously reported in the medical literature. We report a new case of a 41-year-old man presenting a goiter with primary hypothyroidism (thyroid-stimulating hormone, 70 mIU/L; free thyroxine, < 0.01 pmol/L; triiodothyronine, 0.66 nmol/L) and elevation of thyroid antibodies. Several fine-needle aspiration biopsies of the thyroid were fruitless and total thyroidectomy was performed. Histologic and immunohistochemical study demonstrated the polyclonal nature of the cells and yielded a diagnosis of plasma cell granuloma. Histologic findings of Hashimoto thyroiditis were present too.

Feline plasma cell pododermatitis: a study of 8 cases

Eight cases of feline plasma cell pododermatitis, collected over a 3-year period, were studied using histological (haematoxylin and eosin), histochemical (methyl green-pyronin) and immunohistochemical (antibody against lambda light chains of immunoglobulins) techniques. No sex, breed or age predisposition, or paw predilection was observed. The disease began as a swelling of the footpads, followed by ulceration. Histologically, lesions were characterized by the presence of a large number of plasma cells in a predominantly perivascular pattern. Binucleated plasma cells and mitotic figures were observed. Clinical follow-up for over 1 year revealed total remission of the lesions both after glucocorticoid therapy in four cases, and total surgical excision in two animals. Follow-up studies were not possible in one case.

Recurrent inflammatory pseudotumors in children

BACKGROUND/PURPOSE

pulmonary (PPT) and extrapulmonary pseudotumors (EPPT) are uncommon benign tumors, which, in general, do not recur after complete resection. Recurrence rates for both types of pseudotumors are undocumented in a large population of children, and the salient features of potential recurrences are unspecified.

METHODS

This is a report of 15 children with PPT and EPPT; 3 children had a recurrence. These pseudotumors recurred despite adequate primary resection of all gross disease at first presentation. The literature was reviewed to determine rate of recurrence for PPT and EPPT and also to document features common to recurrent pseudotumors.

RESULTS

Overall recurrence rate for pseudotumors was 14%. PPT and EPPT, which were not confined to a single organ, had a high chance of recurrence (46% and 30%, respectively) compared with PPT and EPPT, which were confined to a single organ (1.5% and 8%, respectively). Recurrences have appeared between 3 months and 7 years. Intraabdominal EPPT accounts for more than 75% of the EPPT recurrences.

CONCLUSIONS

PPT and EPPT recur more frequently than anticipated. All pseudotumors, which on initial presentation extend beyond the confines of a single organ, have a high chance of recurrence despite what appears to be adequate resection. Children with pseudotumors that extend beyond a single organ, require frequent postoperative evaluation for recurrence and may be candidates for chemotherapy or radiotherapy at the time of initial resection.

Inflammatory myofibroblastic tumour of the spinal cord: case report and review of the literature

Inflammatory myofibroblastic tumours (IMT), also called inflammatory pseudotumours, nodular lymphoid hyperplasia, plasma-cell granuloma and fibrous xanthoma, are rare soft-tissue lesions characterised by inflammatory cells and a fibrous stroma. Clinically and radiologically, they may look like malignant tumours. They rarely affect the central nervous system and are very rare in the spinal cord. We report an IMT of the spinal cord in a 22-year-old woman presenting with spinal cord compression and a cauda equina syndrome. MRI showed a lesion at T9 with extramedullary and intramedullary components giving low signal on T2-weighted images and enhancing homogeneously. Pial lesions on the lumbar enlargement and thoracic spinal were present 11 months after surgery, when the lesion recurred. We present the radiological, operative and pathological findings and review the literature.

Magnetic resonance imaging of pseudotumors of the craniovertebral junction in long-term hemodialysis patients

BACKGROUND/AIMS

Pseudotumors of the craniovertebral junction (PTCVJ) are observed in long-term hemodialysis (HD) patients. There are neither criteria for diagnosis nor guidelines for screening. We attempted to determine magnetic resonance imaging (MRI) findings that could be used to detect PTCVJ, to determine the prevalence of PTCVJ, and to evaluate whether destructive spondyloarthropathy (DSA) might be a yardstick for selection of patients for MRI examination for PTCVJ.

METHODS

MRI were examined in 19 DSA patients (8 males, 11 females, age 61.4 +/- 7.3 years, HD duration 17.0 +/- 4.4 years) and in 20 sex-, age-, and HD-duration-matched non-DSA patients (9 males, 11 females, age 57.5 +/- 6.6 years, HD duration 17.7 +/- 4.9 years). We evaluated MRI characteristics of PTCVJ according those which occur due to rheumatoid arthritis.

RESULTS

PTCVJ were characterized as follows: disappearance of fat pads in the upper region (supradental PTCVJ), intensity change of the 'predental triangle' in the anterior region (predental PTCVJ), and thickening of cruciform ligaments (retrodental PTCVJ). The prevalence of PTCVJ among patients undergoing HD more than 10 years was high (26 out of 39; 66.7%). The prevalence of PTCVJ was not different between DSA and non-DSA groups.

CONCLUSION

We verified that the above MRI findings might be helpful in the detection of PTCVJ. These findings were observed frequently and independently also in patients with DSA.

Inflammatory pseudotumor of the liver and pregnancy

Inflammatory pseudotumor of the liver (IPL) is a rare, nonneoplastic entity of unknown etiology. Our patient represents the first reported case of IPL that was managed conservatively during an intrauterine pregnancy.

Inflammatory pseudotumor of the spleen in a young child

We describe a case of an inflammatory pseudotumor of the spleen in a 5-year-old boy, found incidentally during a physical examination. The boy underwent a hemisplenectomy. The problems in differentiating this disease from lymphoma of the spleen before surgery and the advantages of hemisplenectomy are discussed. This rare disease has previously been described in the spleen in only 28 cases, the youngest being a 16-year-old patient.

Inflammatory pseudotumor of the liver presenting as incidentaloma: report of a case and review of the literature

Inflammatory pseudotumors of the liver represent a rare entity in the world literature, only 53 cases have been reported previously. Patients present with fever, upper abdominal pain, and weight loss. The finding is usually mistaken as a malignant lesion. Therefore most of the reported patients (77.4%, n = 41) underwent surgical therapy including major liver resections in 30 cases, wedge resections in 5 cases, and liver transplantation in 1 case. Only 12 patients (22.6%) were treated conservatively or were observed. We report the case of a 32-year-old woman with the incidental sonographic finding of a hepatic lesion. After contradictory findings in abdominal CT, MRT and hepatic scinti-scans, the diagnosis of an inflammatory pseudotumor could finally be confirmed by laparoscopic guided needle-biopsy. The clinical course of the patient was completely uneventful under observation. Clinopathological features, diagnostic findings, therapeutical options and outcome are discussed reviewing the cases reported in world literature.

Inflammatory pseudotumor of the maxillary sinus: CT and MR findings in six cases

OBJECTIVE

Inflammatory pseudotumor is a chronic inflammatory lesion of unknown origin. The purpose of this study was to analyze the CT and MR findings in six cases of inflammatory pseudotumor of the maxillary sinus in order to determine if there were any imaging findings that distinguish this lesion from the more common type of pseudotumor that occurs in the orbit.

MATERIALS AND METHODS

Six patients with pseudotumor of the maxillary sinus were identified retrospectively. The diagnosis was based on biopsy specimens. Their CT scans and MR images were studied by two radiologists to identify specifically the presence of soft-tissue disease and the presence and type of any bone involvement.

RESULTS

CT and MR images showed some degree of involvement of the bony wall in all cases. All patients had a soft-tissue mass with mild enhancement on CT scans and intermediate signal intensity on both T1- and T2-weighted MR images.

CONCLUSION

Our experience shows that inflammatory pseudotumor of the maxillary sinus causes bone changes on CT and MR images, findings that mimic a malignant tumor. Bone involvement appears to be more common in pseudotumor of the maxillary antrum than in its orbital counterpart.

Plasma cell granuloma of the colon: a report of a case removed by endoscopic polypectomy

Plasma cell granuloma of the cecum was resected by endoscopic polypectomy. The immunohistochemical study demonstrated the polyclonal nature of the plasma cells and thus confirmed the diagnosis of plasma cell granuloma.

Inflammatory pseudotumour of the liver: diagnosis by fine needle biopsy in two cases and a review of the literature

Inflammatory pseudotumours of the liver are rare: over 40 cases had been reported up to 1992, the majority of which are surgical or laparoscopic findings. In this paper we describe two additional cases in which diagnosis was acquired by fine needle biopsy under ultrasonographic guidance. This approach allowed sufficient sampling of tissue for diagnostic purposes.

[Castleman's disease localized in the uterus or an inflammatory uterine pseudotumor. A case report and review of the literature]

The authors report a case of Castleman's disease localised to the uterus. The treatment was surgical removal of the lesion with conservation of the uterus. Though in localised forms the prognosis is always favourable, multicentered lesions can suggest lymphoma. In our case that we report the anatomo-pathological appearances were not characteristic and this has led the authors to think of a differential diagnosis such as an inflammatory pseudo-tumour of the uterus of which only two cases have been previously reported.

A case of splenic inflammatory pseudotumor

Inflammatory pseudotumor of the spleen in a 50-year-old man was encountered in our surgical clinic. This splenic tumor is very rare and in the ninth of the cases in the literature. The removed spleen, weighting 255g, revealed the presence of a firm, circumscribed mass, measuring 4.5 x 4.0 x 4.5 cm, and histologically presenting marked lamination of collagen fibers around the small vessels associated with granulomatous lesions. The implications of its pathogenesis was analyzed with a review of the literature.