The Second Department of Internal Medicine
Hiroshima University School of Medicine
Correspondence to: Shinichi Ishioka, MD, FCCP, The Second Department of Internal Medicine, Hiroshima University School of Medicine, 1–2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
To the Editor:
A 56-year-old man was admitted to Hiroshima
University Hospital in 1987 because of radiographic evidence of
pulmonary abnormalities, fever, and anorexia. A radiograph of the chest
showed bilateral thickening of the pleura in the middle field. A CT
scan of the chest disclosed remarkable thickening of the pleura and a
tumorous lesion, 2 × 3.5 cm in diameter, with a low density area in
the right lung (Fig 1
). Because the etiology was unknown except in the lungs, an exploratory
thoracotomy was performed. A microscopic examination of the
resected specimen disclosed that the tumor was composed of a
proliferation of fibroblasts and an infiltration of plasma cells,
macrophages, and lymphocytes accompanied by a local accumulation of
hyaline collagen layers (Fig 2
). Because a low-grade fever and increased levels of C-reactive protein
remained after the operation, 20 mg/d prednisolone was administered.
After 2 weeks of corticosteroid treatment, the symptoms improved, and
the dose of prednisolone was gradually tapered. No recurrence was
observed after 10 years of follow-up.
Inflammatory pseudotumors are rare diseases that generally occurs in
the lung. To our knowledge, there is only one report describing an
inflammatory pseudotumor presenting pleural thickening that showed
spontaneous regression.1Ishida et al2
reported that, intraoperatively, the parietal pleura was involved in
three of seven patients with inflammatory pseudotumors. In our patient,
although the histologic examination of the resected pleura revealed
remarkable fibrosis without evidence of inflammatory pseudotumor
involvement, adjacency between the tumor and the pleural thickening
suggested a relationship of these lesions. After complete resection of
the tumor, the symptoms remained, suggesting an active lesion in the
remaining thickening pleura.
The diagnosis of inflammatory pseudotumor is not commonly made before
resection, and complete resection leads to an excellent
prognosis.3Unresected or recurred cases in patients were
reportedly treated with corticosteroids, which resulted in a decrease
in size or complete regression.4–5 Before corticosteroid
treatment, our patient was treated with nonsteroidal anti-inflammatory
drugs, which were not effective. These observations suggest that
corticosteroids may be an option in treating inflammatory pseudotumors.
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