Original Articles
Inflammatory pseudotumors of the lung

https://doi.org/10.1016/S0003-4975(99)00155-1Get rights and content

Abstract

Background. Inflammatory pseudotumors of the lung are rare and often present a dilemma for the surgeon at time of operation. We reviewed our experience with patients who have this unusual pathology.

Methods. Between February 1946 and September 1993, 56,400 general thoracic surgical procedures were performed at the Mayo Clinic. Twenty-three patients (0.04%) had resection of an inflammatory pseudotumor of the lung. There were 12 women and 11 men. Median age was 47 years (range, 5 to 77 years). Six patients (26%) were less than 18 years old. All pathologic specimens were re-reviewed, and the diagnosis of inflammatory pseudotumor was confirmed. Eighteen patients (78%) were symptomatic which included cough in 12, weight loss in 4, fever in 4, and fatigue in 4. Four patients had prior incomplete resections performed elsewhere and underwent re-resection because of growth of residual pseudotumor. Wedge excision was performed in 7 patients, lobectomy in 6, pneumonectomy in 6, chest wall resection in 2, segmentectomy in 1, and bilobectomy in 1. Complete resection was accomplished in 18 patients (78%). Median tumor size was 4.0 cm (range, 1 to 15 cm). There were no operative deaths. Follow-up was complete in all patients and ranged from 3 to 27 years (median, 9 years).

Results. Overall 5-year survival was 91%. Nineteen patients are currently alive. Cause of death in the remaining 4 patients was unrelated to pseudotumor. The pseudotumor recurred in 3 of the 5 patients who had incomplete resection; 2 have had subsequent complete excision with no evidence of recurrence 8 and 9 years later.

Conclusions. We conclude that inflammatory pseudotumors of the lung are rare. They often occur in children, can grow to a large size, and are often locally invasive, requiring significant pulmonary resection. Complete resection, when possible, is safe and leads to excellent survival. Pseudotumors, which recur, should be re-resected.

Section snippets

Patients and data collection

Between February 1946 and September 1993, 56,400 general thoracic surgical procedures were performed at our institution. These operations consisted of pulmonary, esophageal, and chest wall resections, as well as mediastionoscopies and video-assisted procedures. Twenty-three patients (0.04%) had resection of an inflammatory pseudotumor of the lung. All pathologic slides were re-reviewed by a single pathologist and were confirmed to be inflammatory pseudotumor. The records were reviewed for age,

Results

Pneumonectomy was performed in 6 patients, bilobectomy in 1, lobectomy in 6, segmentectomy in 1, wedge resection in 7, and chest wall resection in 2. All patients had mediastinal and intrapulmonary lymph node resection, and no nodes were involved with pseudotumor in any patient. Complete resection of the mass was accomplished in 18 patients (78%). In 5 patients, who underwent incomplete resection, residual tumor was left on the chest wall in 2, in the lung in 2, and on the superior vena cava in

Comment

Because of the numerous synonyms used for inflammatory pseudotumor of the lung (plasma cell granuloma, xanthoma, fibroxanthoma, histiocytoma, plasmacytoma, solitary mast cell tumor, and pseudoneoplastic pneumonia of the lung) little is known about its true incidence, natural history, and response to different treatments. To ensure that all patients in our series had inflammatory pseudotumors, all pathologic slides were rereviewed by a single pathologist (A.G.N.). The classic histiologic

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