title: [Pulmonary hyalinizing granuloma].
abstract: Benign lesions as pulmonary hyalinizing granuloma may mimic a malign disease. A 63-year old patient complained dyspnea and a weight loss of 30 kg. CT-thorax scans showed a destructive and infiltrative pulmonary process with pleural thickening. Histologic examination of transbronchial and transthoracic biopsies as well as of biopsies taken by minithoracotomy was not conclusive. Due to further progression the patient underwent a left-sided pleuropneumonectomy despite a VO2 peak of 9 ml/kg/min. Histology revealed DIP-like infiltrations, a histiocytic reaction and hyaline granulomas. Among less than 100 published cases of pulmonary hyaline granuloma a comparable rapid progression with a total functional loss of the affected lung is not reported. Mostly hyalinizing granuloma presents with infiltrations, which may mimic lung cancer, or nodular lesions, partly with cavitations or calcifications. The etiology is unknown, a persistent immunologic response to an antigenic stimulus is discussed. Associations with infections, lymphomas, amyloidosis or IgG4-related disease are reported. Some cases have features of multifocal fibrosis. In the case reported none of these associations could be found. The prognosis of pulmonary hyaline granuloma is regarded as benign. There is no effective treatment yet. Once the diagnosis has been established a conservative approach as well as a resection of nodules and a therapeutic attempt with steroids are an option. Extensive resections as pleuropneumonectomy are an exception.
authors.affiliation: Klinik für Pneumologie, Schlaf- und Beatmungsmedizin, Lungenklinik Hemer.
authors.forename: M
authors.initials: M
authors.lastname: Westhoff
authors.affiliation: Klinik für Pneumologie, Schlaf- und Beatmungsmedizin, Lungenklinik Hemer.
authors.forename: P
authors.initials: P
authors.lastname: Litterst
authors.affiliation: Klinik für Thoraxchirurgie - Lungenklinik Hemer.
authors.forename: M
authors.initials: M
authors.lastname: Albert
authors.affiliation: Institut für Pathologie, Hemer.
authors.forename: B
authors.initials: B
authors.lastname: Welim
mesh_terms: D003937:Diagnosis, Differential; D015769:Granuloma, Respiratory Tract / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome