PURPOSE: Granulomas are focal collection of inflammatory cells occurring as a response to antigenic challenge found on resection of small nodules or incidental findings in lung specimens for other causes. The aim of this study was to evaluate the causes of granulomas and outcome in lung specimens obtained at a cancer center.
METHODS: Granulomas in lung pathology specimens identified by pathology data base ( 01/01/2002 to 12/31/2006).
RESULTS: A total 65 specimens found; 29 M and 37 W, median age 64 yrs, (13 to 90 yrs). We characterized 25 as primary granulomas (PG) –sole pathology; 17 as incidental granulomas (IG), in lung separate from primary process (all cancers) and 23 as associated granulomas (AG), in close proximity to another pathologic process (19 cancers, 2 BOOP, 1 pulmonary sequestration, 1 acute b/l infiltrates). Necrotizing granulomas (NG) in 44 (68%); 68% of PG, 82% of IG, and 57% of AG. Infections in 19 pts (29%); 44% of PG, 41% of IG and 4.3% of AG. Organisms found by smear 11, culture 11, both in 3, including mycobacteria 11 (2 TB); fungal 5; bacterial 4. All NG. 15 pts with infection followed; 6 treated, remainder observed. Sarcoid found in 5 cases; 3 PG, 2 AG, Hypersensitivity pneumonitis in one. In the remaining 40 pts with unknown cause had focal findings of bronchiolitis in 6, and organizing pneumonia in 6. Most patients under prolonged observation and continued treatment for other underlying diseases, including cancer had no additional diagnosis found.
CONCLUSION: For granulomas found, a cause identified in 25 (38%) cases with infection in 28%. Infection more likely with NG (42%) and PG (44%) or IG (41%) groups. In cases of unknown etiology, no additional diagnoses found under observation and treatment for cancer in some cases.
CLINICAL IMPLICATIONS: In granulomas found by pathology at a cancer center, infection found in less than half, even if NG but outcome for all patients was favorable.
DISCLOSURE: Ilona Belinskaya, No Financial Disclosure Information; No Product/Research Disclosure Information