Bronchocentric granulomatosis with mucus impaction due to bronchogenic carcinoma. An association with clinical relevance.
OBJECTIVE
To describe an unexpected inflammatory process associated with malignancy in the lung and to postulate a new mode of pathogenesis.


METHODS
Retrospective review of surgical pathologic findings.


METHODS
Academic hospital pathology department.


METHODS
Four patients, 2 men and 2 women, ranging in age from 45 to 74 years, each of whom had a solitary mass on chest radiographs.


METHODS
Pulmonary lobectomy.


METHODS
Histopathologic identification of bronchocentric granulomatosis.


RESULTS
Accompanying a bronchogenic carcinoma in each case was a necrotizing chronic granulomatous reaction centered around bronchioles that were plugged with mucus, necrotic detritus from the tumor, lipid, or a combination of these substances. Eosinophils were present in small numbers in one case. The pathologic findings characterize bronchocentric granulomatosis.


CONCLUSIONS
The presence of bronchocentric granulomatosis in the biopsy of a mass does not exclude the presence of an accompanying bronchogenic carcinoma associated with obstruction of bronchioles. Bronchocentric granulomatosis in some cases may represent an immunologic response to tumor detritus or lipid, as well as to mucus impaction.
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
S L
SL
Houser
E J
EJ
Mark
D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D000368:Aged; D001982:Bronchial Diseases / Q000209:etiology / Q000473:pathology*; D002283:Carcinoma, Bronchogenic / Q000150:complications / Q000473:pathology* / Q000601:surgery; D018287:Carcinoma, Large Cell / Q000150:complications / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D015769:Granuloma, Respiratory Tract / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009093:Mucus / Q000166:cytology*; D012189:Retrospective Studies