Clinicoradiological Features of Pulmonary Infarctions Mimicking Lung Cancer

George, Catherine; Tazelaar, Henry D.; Swensen, Stephen J.; Ryu, Jay H.

doi:10.4065/79.7.895

Cited by 23 publications

(17 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4,7,13 Nonetheless, in only three cases where CT scan reports were available did the radiologist raise the possibility of thromboemboli and infarction, possibly reflecting the peculiar low-magnification characteristics that we have described. Radiologic descriptions highlight the pleural-based nature of the lesion, often seen in the lower lobes, with the apex of the wedge-shaped infarct pointing toward the thrombosed vessel and a convex border (Hampton's hump) reflecting the hemorrhage and bulging of the interlobular septa and/or compressed lung parenchyma.…”

Section: Discussionmentioning

confidence: 78%

“…Such epithelial atypia is a well-reported problem in fine needle aspirations and other cytologic preparations with pulmonary infarcts as such cases have been overcalled as malignant. 4,10,21 This was a problem in several of our consultation cases too.…”

Section: Discussionmentioning

confidence: 86%

“…[2][3][4][5][6][7][8] These wedge-shaped subpleural zones of hemorrhage and coagulative necrosis are rare due to the triple supply of oxygen to the lung from the bronchial and pulmonary arteries and air of the tracheobronchial tree as well as the intrinsically high fibrinolytic activity of pulmonary endothelial cells. [9][10][11] Nonetheless, in the setting of chronic cardiovascular or pulmonary disease, thromboembolic infarcts occur and are common in autopsy series, often representing a major cause of sudden death.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to the pathology literature, it is well recognized in thoracic radiology that infarcts may have an irregular and spiculated appearance in a minority of instances. [4][5][6][7]9,[12][13][14][15][16] In 52% of cases, the coagulative necrosis of parenchyma was punctuated with basophilic necrosis where parenchymal cells, histiocytes, and leukocytes were undergoing degeneration resulting in low power streaks of 'leukocytoclasis' or 'pathergic necrosis' much as one sees in Wegener's granulomatosis. 17 This hematoxyphilic change to the zones of coagulative necrosis and hemorrhage was not predicted given the usual emphasis on hemorrhage and bland ischemic necrosis of parenchyma in infarcts.…”

Section: Discussionmentioning

confidence: 99%

“…Radiologic descriptions highlight the pleural-based nature of the lesion, often seen in the lower lobes, with the apex of the wedge-shaped infarct pointing toward the thrombosed vessel and a convex border (Hampton's hump) reflecting the hemorrhage and bulging of the interlobular septa and/or compressed lung parenchyma. 4,5,9,11,13,15 Coinciding with the atypical radiologic presentation, patients did not characteristically present with hemoptysis, chest pain, and pleurisy with the vast majority of patients identified by nonspecific complaints of cough or shortness of breath or by screening radiographic exams for metastatic carcinoma. A significant percentage of our patients did, however, have risk factors for pulmonary thromboemboli and infarcts, confirmed in postoperative studies.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

The surgical pathology of pulmonary infarcts: diagnostic confusion with granulomatous disease, vasculitis, and neoplasia

Yousem

2009

Modern Pathology

View full text Add to dashboard Cite

Twenty-three cases of surgically resected pulmonary infarcts sent in consultation were reviewed to evaluate their morphology and to assess reasons for consultation. The morphology of these infarcts demonstrated that only a minority had the classical triangular shape at low magnification (26%) whereas the majority were either spherical (17%) or had a geographic pattern of necrosis (35%). The margin of the infarcted tissue often had a pseudogranulomatous appearance due to palisaded histiocytes, foam cells, or perpendicularly oriented proliferations of fibroblasts and myofibroblasts (74%) and occasional cholesterol-and hemosiderin-laden giant cells. Basophilic granular karyorrhectic necrosis was seen focally (52%) as was vascular inflammation (56%) raising the differential diagnosis of Wegener's granulomatosis or infectious granulomas. These nonclassical features combined with a low incidence of clinical hemoptysis, chest pain and pleurisy, and a primary radiographic diagnosis of 'nodule r/o malignancy' highlight the need to consider thromboembolic pulmonary infarcts in the differential diagnosis of necrotic lung nodules with a histiocytic and fibroproliferative rim. Keywords: infarct; thromboemboli; lung Discussions of pulmonary thromboemboli and pulmonary infarcts most often occur in the autopsy suite rather than the surgical pathology laboratory. In fact, some renowned textbooks on pulmonary surgical pathology have failed to discuss the pathology of thromboemboli or infarcts at all, leaving such descriptions to basic pathology textbooks such as Robbins. 1 We have recently encountered a number of pulmonary infarcts that have been resected surgically, often to exclude neoplasia, which have proven diagnostically problematic to surgical pathologists who have referred them as granulomatous disease, vasculitis, and neoplasia. This precipitated a review of our files and a histologic study of surgically resected thromboembolic pulmonary infarcts to highlight their morphologic spectrum including variations from classical descriptions. Materials and methodsSeventy-eight cases of pulmonary infarcts were retrieved from the consultation files and the surgical pathology archives of the University of Pittsburgh Medical Center between 1994 and 2008. Of these 23 cases were specifically selected as being a result of thromboembolic disease rather than other causes of pulmonary infarction, including neoplasia, infection, vasculitis, amyloid, intravascular foreign bodies, septic infarcts, diffuse alveolar damage, torsion, and amniotic fluid emboli; 10 were reviewed within the last 2 years. Only wedge/ segmental biopsies of the lung were reviewed; four core biopsies of thromboembolic pulmonary infarcts were excluded from consideration.From 6 to 34 (mean 6) hematoxylin and eosin stain slides were available for review from each case. Ziehl-Nielsen and Gomori methenamine silver stains were reviewed and interpreted as negative in all cases. Verhoeff-van Gieson elastic tissue stains were carried out in 18 cases. Relevant clinical and radi...

show abstract

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 86%