title: Pulmonary hyalinizing granuloma: a multicenter study of 5 new cases and review of the 135 cases of the literature.
abstract: Pulmonary hyalinizing granuloma (PHG) is a rare disease characterized by single or multiple benign lung nodules mimicking lung neoplasma. Histologic analysis reveals homogenous hyaline lamellae, usually surrounded by collection of plasma cells, lymphocytes and histiocytes in a perivascular distribution. The clinical and radiological findings have been described in small series, but the long-term outcomes have rarely been reported. The objectives were to describe the clinical, radiological and outcomes of PHG in new cases and through a literature review. Patients with PHG were found by a multicenter search among French departments of internal medicine, pulmonology and anatomo-pathology. Review of the literature was made through the National Library of Medicine's MEDLINE database using keywords "hyalinizing granuloma." Five news cases and 135 cases of the literature were found. There were 82 men and 57 women, mean age at the diagnosis 44.6 years (15-83). Patients were frequently asymptomatic (n = 39, 27.4 %). The nodule was unique in 37 cases (28.9 %) and multiple in 91 cases (71.1 %). 18FDG PET scan revealed hypermetabolism of the nodule in 9/15 cases (60 %). A systemic disease was associated in 65 cases (mainly mediastinal and retroperitoneal fibrosis, autoimmune, tumoral or infectious disease or thromboembolism). The outcomes were evaluated in 73 patients when follow-up was available: 14 patients had a surgical resection of the nodule. Forty-five patients did not receive any immunosuppressive drug. Among these patients, 2 improved, 29 were stable and 14 worsened. Corticosteroids were used as a monotherapy in 19 patients and led to radiological improvement in 8 cases, stabilization in 8 cases and worsening in 3 cases. Five patients were treated with corticosteroids and at least one immunosuppressive drug and 4 patients improved. PHG is a rare benign disease, mimicking lung neoplasma, frequently associated with systemic diseases.
authors: Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
authors: Raphael
authors: R
authors: Lhote
authors: Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France.
authors: Julien
authors: J
authors: Haroche
authors: Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
authors: Loïc
authors: L
authors: Duron
authors: Service de Pneumologie, Centre National de Référence des Maladies Pulmonaires Rares Centre Expert National associé du Réseau RYTHMIC Tumeurs Thymiques et Cancer, Hôpital Louis Pradel, Lyon, France.
authors: Nicolas
authors: N
authors: Girard
authors: Service de Pneumologie, Centre Hospitalier d'Angoulême, Angoulême, France.
authors: Marie Pierre
authors: MP
authors: Lafourcade
authors: Service de Pneumologie, Centre Hospitalier d'Angoulême, Angoulême, France.
authors: Michel
authors: M
authors: Martin
authors: Service d'Anatomo-Pathologie, Centre Hospitalier de Pessac, Pessac, France.
authors: Hugues
authors: H
authors: Begueret
authors: Service de Pneumologie, Centre Hospitalier de Pessac, Pessac, France.
authors: André
authors: A
authors: Taytard
authors: Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France.|Service d'Anatomo-pathologie, AP-HP, Groupe Hospitalier Pitié Salpêtrière, Paris, France.
authors: Frédérique
authors: F
authors: Capron
authors: Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France.|Service de Radiologie, AP-HP, Groupe Hospitalier Pitié Salpêtrière, Paris, France.
authors: Philippe
authors: P
authors: Grenier
authors: Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France.
authors: Jean Charles
authors: JC
authors: Piette
authors: Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. fleur.cohen@aphp.fr.|Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France. fleur.cohen@aphp.fr.
authors: Fleur
authors: F
authors: Cohen-Aubart
authors: Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|Université Pierre et Marie Curie, Paris VI, Sorbonnes Universités, 75013, Paris, France.
authors: Zahir
authors: Z
authors: Amoura
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006099:Granuloma / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D006818:Hyalin; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents
keywords: 18FDG PET scan; Hyalinizing granuloma; Lung nodule