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Pulmonary Hyalinizing Granuloma (PHG): An Uncommon Cause of Pulmonary Nodules
Diffuse Lung Disease SESSION TITLE: Diffuse Lung Disease SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Sunday, October 29, 2017 at 10:45 AM - 12:00 PM
Pulmonary Hyalinizing Granuloma (PHG): An Uncommon Cause of Pulmonary Nodules Mathieu Saint-Pierre* Alexander Boag Onofre Moran-Mendoza and Chris Parker Queen’s University, Kingston, ON, Canada INTRODUCTION: PHG is a very rare benign lung disease, which typically presents as multiple randomly distributed pulmonary lesions. We describe a case that was diagnosed after numerous investigations were carried out. CASE PRESENTATION: A 29-year-old Caucasian female presented with a 5-month history of non-productive cough, exertional dyspnea (MRC 3/5) and pleuritic chest pain. She lived in Eastern Ontario, Canada, and denied recent travel. She was an exsmoker (< 5 pack-year history) and did not use illicit drugs. She had no relevant past medical history. Physical examination was unremarkable. Blood work was noncontributory. Chest computed tomography (CT) revealed multiple bilateral randomly distributed pulmonary nodules, as well as cystic lesions (Images 1 and 2). Cultures and cytology from bronchoscopy washings were negative. Subsequently, a CT-guided lung biopsy of a right upper lobe nodule showed only nonspecific inflammation and fibrosis. No evidence of extrapulmonary involvement was found. Repeat chest CT showed interval increase in the number and size of the pulmonary nodules and cysts. Therefore, the patient was referred for a right upper lobe wedge resection. Histopathology revealed nodules of dense lamellar collagen with a significant number of surrounding plasma cells and lymphocytes. The specimen was negative for malignancy, vasculitis and infection. Pathology slides were reviewed at several North American centers, and a diagnosis of PHG was ultimately established.
CONCLUSIONS: PHG is a rare lung disease that can mimic many other pulmonary pathologies. It must therefore be included in the differential diagnosis of those presenting with pulmonary nodules or masses. No definitive treatment is currently available. Reference #1: Gans et al. Pulmonary hyalinizing granuloma. European Respiratory Journal 1988; 1 (4): 389-391. Reference #2: Brandao et al. Hyalinizing granuloma: an unusual case of a pulmonary mass. Case Reports in Medicine 2010; Article 984765. DISCLOSURE: The following authors have nothing to disclose: Mathieu Saint-Pierre, Alexander Boag, Onofre Moran-Mendoza, Chris Parker No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.462
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
chestjournal.org
435A
DIFFUSE LUNG DISEASE
DISCUSSION: Multiple random pulmonary lesions are found in most PHG cases, and these can vary significantly in size. Cavitary or cystic changes are relatively uncommon features. Most patients are symptomatic at the time of diagnosis: cough, dyspnea and chest pain are frequently reported. Its pathophysiology is unclear but hypothesized to be related to an exaggerated immune response, and most cases appear to be idiopathic. (1) The prognosis is generally considered to be good. Corticosteroids have been attempted in several reports but radiographic improvement has rarely been observed. (2)
Pulmonary Hyalinizing Granuloma (PHG): An Uncommon Cause of Pulmonary Nodules Mathieu Saint-Pierre* Alexander Boag Onofre Moran-Mendoza and Chris Parker Queen’s University, Kingston, ON, Canada INTRODUCTION: PHG is a very rare benign lung disease, which typically presents as multiple randomly distributed pulmonary lesions. We describe a case that was diagnosed after numerous investigations were carried out. CASE PRESENTATION: A 29-year-old Caucasian female presented with a 5-month history of non-productive cough, exertional dyspnea (MRC 3/5) and pleuritic chest pain. She lived in Eastern Ontario, Canada, and denied recent travel. She was an exsmoker (< 5 pack-year history) and did not use illicit drugs. She had no relevant past medical history. Physical examination was unremarkable. Blood work was noncontributory. Chest computed tomography (CT) revealed multiple bilateral randomly distributed pulmonary nodules, as well as cystic lesions (Images 1 and 2). Cultures and cytology from bronchoscopy washings were negative. Subsequently, a CT-guided lung biopsy of a right upper lobe nodule showed only nonspecific inflammation and fibrosis. No evidence of extrapulmonary involvement was found. Repeat chest CT showed interval increase in the number and size of the pulmonary nodules and cysts. Therefore, the patient was referred for a right upper lobe wedge resection. Histopathology revealed nodules of dense lamellar collagen with a significant number of surrounding plasma cells and lymphocytes. The specimen was negative for malignancy, vasculitis and infection. Pathology slides were reviewed at several North American centers, and a diagnosis of PHG was ultimately established.
CONCLUSIONS: PHG is a rare lung disease that can mimic many other pulmonary pathologies. It must therefore be included in the differential diagnosis of those presenting with pulmonary nodules or masses. No definitive treatment is currently available. Reference #1: Gans et al. Pulmonary hyalinizing granuloma. European Respiratory Journal 1988; 1 (4): 389-391. Reference #2: Brandao et al. Hyalinizing granuloma: an unusual case of a pulmonary mass. Case Reports in Medicine 2010; Article 984765. DISCLOSURE: The following authors have nothing to disclose: Mathieu Saint-Pierre, Alexander Boag, Onofre Moran-Mendoza, Chris Parker No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.462
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
chestjournal.org
435A
DIFFUSE LUNG DISEASE
DISCUSSION: Multiple random pulmonary lesions are found in most PHG cases, and these can vary significantly in size. Cavitary or cystic changes are relatively uncommon features. Most patients are symptomatic at the time of diagnosis: cough, dyspnea and chest pain are frequently reported. Its pathophysiology is unclear but hypothesized to be related to an exaggerated immune response, and most cases appear to be idiopathic. (1) The prognosis is generally considered to be good. Corticosteroids have been attempted in several reports but radiographic improvement has rarely been observed. (2)