Inflammatory pseudotumors (IPT) of the lung are rare benign non-neoplastic unregulated growth of inflammatory cells. IPT may mimic lung cancer and pose diagnostic and therapeutic dilemma. The standard procedure, for both diagnosis and treatment, is surgical resection. Non surgical modalities have been employed in patients in whom resection was incomplete, in whom there has been recurrence, or who are poor surgical candidates. There are anecdotal reports of both success and failure with radiotherapy and corticosteroids. To our knowledge, spontaneous regression is extremely rare. We herein, report a case of IPT of the lung that was treated without surgery and that subsequently spontaneously resolved.
A 50 year old woman presented with dyspnea and a right sided chest pain of 4 weeks. The patient reported having a productive cough, fever and shortness of breath of 4 days, for which she went to a nearby hospital and was given 2 weeks course of antibiotics. The cough and fever subsided but she continued to have dyspnea and chest pain and was referred to our chest clinic. Review of systems is significant for loss of appetite and 5kgs weight loss. She had no fever, cough, sputum purulence or heamoptysis at the time of presentation to the chest clinic. On physical examination, temperature, pulse rate, respiratory rate, and BP were normal. The results of auscultation of the lung and heart were normal. There were no abdominal, rectal, or breast masses palpated, and there was no lypmhadenopathy. Routine hematological and biochemical tests as well as urinalysis were unremarkable. Her PPD and Sputum for AFP were negative. Chest CT revealed mass-like density in superior segment of RLL with extension to posterior pleura measuring 4.8 × 4.5 × 4.7 cm, there were no mediastinal or hilar adenopathy, or pleural effusions. Bronchial washing stains for fungi and for mycobacterium as well as cytology examination for malignant cells were negative. Pathological examination of trasbronchial biopsy specimens showed inflammatory pseudotumor, fibro-histiocytic subtype and organizing pneumonia.Serial follow up imaging studies showed spontaneous resolution of the lung mass .The patient was managed conservatively without surgical resection.
IPT constitute less than 1% of all lung tumors. The precise etiology is unknown, but a number of researchers believe that the inflammatory pseudotumor is in fact a regular inflammatory process which follows an interstitial pneumonia. Then, it transforms into an organized pneumonia and eventually, to an inflammatory pseudotumor. Forty to 70% of patients are symptomatic at presentation with cough, fever, chest pain, dyspnea, or heamoptysis. Laboratory investigations usually yield normal results. Chest radiographs usually show a solitary nodule or mass typically located in the peripheral portions of the lower lobes. Because IPT can demonstrate aggressive behavior and have overlapping clinical and pathologic features with inflammatory sarcomas, complete surgical excision is generally considered the treatment of choice. Steroid therapy is usually not helpful. Chemotherapy has been used to treat multifocal lesions and recurrence.
In conclusion, inflammatory pseudotumors are uncommon benign lesions of the lung. The diagnosis is seldom confirmed preoperatively, and the treatment of choice is surgical. The total regression of the lung mass in this case, without any treatment, illustrates a very unusual outcome of these pseudotumors. Our report provides documentation of spontaneous resolution of IPT of the lung.
Shahla Naoman Gull, No Financial Disclosure Information; No Product/Research Disclosure Information