title: Chickenpox-related pulmonary granulomas in immunocompetent adults: clinicopathologic and molecular features of an underrated occurrence.
abstract: Pulmonary granulomas represent a common inflammatory reaction to several lung infective or noninfective diseases. However, little is known about the histology and clinical presentation of chickenpox-related granulomas in immunocompetent subjects. We collected a series of 8 adult patients (mean age, 40 y; range, 33 to 53 y) with several bilateral pulmonary granulomas incidentally discovered after imaging studies. All patients were asymptomatic and had experienced a varicella-zoster virus (VZV) infection as adults but were clinically suspected to have a metastatic neoplasm of unknown origin. Chest computed tomography scan revealed numerous, tiny (few millimeters to 1 cm in size) nodules randomly dispersed through the lungs. Positron emission tomography scan performed in 4 patients was negative. All patients underwent video-assisted thoracoscopic surgical resection and were still alive and well. At histology, granulomas consisted of well-defined, rounded, small nodules centered by a deeply eosinophilic, acellular necrosis rimmed by lamellar dense collagen and a chronic inflammatory infiltrate with or without multinucleated giant cells. Chickenpox-related granulomas were included in the differential diagnosis along with several other granulomatous diseases. Polymerase chain reaction-based molecular analysis for VZV performed on paraffin sections detected VZV DNA in all 8 cases. By contrast, 85 cases of pulmonary granulomas of different etiologies were simultaneously studied by molecular analysis with negative results. Pathologists should be familiar with the peculiar morphologic appearance of chickenpox-related granulomas. A careful search for a history of VZV infection in adulthood and molecular studies may be very helpful in confirming the diagnosis.
authors.affiliation: Section of Pathologic Anatomy, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy. rossi.giulio@policlinico.mo.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Rossi
authors.forename: Alberto
authors.initials: A
authors.lastname: Cavazza
authors.forename: William
authors.initials: W
authors.lastname: Gennari
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marchioni
authors.forename: Paolo
authors.initials: P
authors.lastname: Graziano
authors.forename: Antonella
authors.initials: A
authors.lastname: Caminati
authors.forename: Maria Cecilia
authors.initials: MC
authors.lastname: Mengoli
authors.forename: Rita
authors.initials: R
authors.lastname: Magnani
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Colby
mesh_terms: D000328:Adult; D002644:Chickenpox / Q000175:diagnosis / Q000473:pathology* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015769:Granuloma, Respiratory Tract / Q000175:diagnosis / Q000473:pathology* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007121:Immunocompetence; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D004279:DNA, Viral