Lung Pathology |

Cavitating Myofibroblastic Tumor of the Lung FREE TO VIEW

Puneet Aulakh, MD; Thomas Dillard, MD; James Smith, MD
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Georgia Regents University, Augusta, GA

Chest. 2015;148(4_MeetingAbstracts):604A. doi:10.1378/chest.2281175
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SESSION TITLE: Lung Pathology Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Myofibroblastic tumors of lung have a highly variable clinical course that includes potential for malignant transformation, local invasion and metastases. Treatment is usually surgical resection. We report a case of spontaneous regression of a cavitary myofibroblastic tumor in a male smoker.

CASE PRESENTATION: A 60 year old male smoker was incidentally found to have a left upper lobe cavitary lesion on a chest radiograph. He denied any prior exposure or history of tuberculosis. He had an occasional cough without sputum or hemoptysis. He reported anorexia with a 20 pound weight loss over the past 3 to 4 months. A chest CT scan showed a 5 by 4 by 3 cm cavitating, left upper lobe mass (Fig 1). Bronchial washings and brushings were negative for cytology, AFB and fungi. CT guided core needle biopsies showed a myofibroblastic tumor with positive immunohistochemistry for smooth muscle actin (SMA) in spindle cells as well as macrophages, plasma cells, and scattered B- and T- lymphocytes. Surgery was initially recommended by the interdisciplinary thoracic tumor board. Repeat chest CT prior to the scheduled surgery showed near complete resolution of the cavitary mass with minimal residual density. Subsequent follow up in the pulmonary clinic has revealed no recurrence of the tumor to date (Fig 2).

DISCUSSION: Myofibroblastic tumors are uncommon in adults. The nomenclature for this tumor includes pulmonary inflammatory myofibroblastic tumors (PIMT), plasma cell granuloma, fibrous histiocytoma, fibroxanthoma, inflammatory pseudotumor or xanthogranuloma. These tumors most commonly present as solitary pulmonary nodules. Associated features may include viral infections such as HHV-8 or EBV, other infections, autoimmune diseases, immunosuppression, and tissue staining for anaplastic lymphoma kinase (ALK) in some cases. Symptoms, in order of prevalence, include cough, chest pain, hemoptysis and sputum production. Surgery is the curative treatment of choice.

CONCLUSIONS: Myofibroblastic tumors of lung are uncommon in the adult population.Thorough histopathologic evaluation can distinguish these tumors from epithelial tumors of lung. Complete surgical resection is the usual treatment. Long term follow up is recommended. Future recognition of prognostic features that may aid in the decision to proceed with or defer surgery would be welcome.

Reference #1: Am J Case Rep. 2014 Jun 17 Cavitating lung lesion as a manifestation of inflammatory tumor (pseudotumor) of the lung: A case report and literature review. Michaelides SA et al

DISCLOSURE: The following authors have nothing to disclose: Puneet Aulakh, Thomas Dillard, James Smith

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