Hyalinizing Granuloma: An Unusual Case of a Pulmonary Mass

Abstract

We describe the case of pulmonary hyalinizing granuloma in a 34-year-old asymptomatic man who presented with a pulmonary nodule apparent by chest radiography and computed tomography (CT). He had a history of previous treatment for tuberculosis. His laboratory data were normal. Bronchoscopy and CT-guided percutaneous transthoracic fine needle aspiration cytology were inconclusive. The diagnosis was revealed after the histopathological examination of an open lung biopsy.

Pulmonary Hyalinizing Granuloma in the Differential Diagnosis of Pulmonary Carcinoma

“…Among them; sclerosing mediastinitis, retroperitoneal fibrosis, rheumatoid arthritis, uveitis, ocular papillitis and neoplastic diseases (abdominal lymphoma, multiple myeloma, Paget's disease of the breast) can be observed [1,2,4,13]. It has been hypothesized that all of these conditions may essentially represent the same reactive response of an immunologic mechanism triggered by infectious agents [6]. However, in our case there was no additional pathology.…”

“…The radiological appearance of the lesion is that of multiple, bilateral nodules which sometimes mimic metastatic carcinoma [1][2][3]. Although the etiopathogenesis of PHG is unknown, it has been postulated that it represents an exaggerated immune response, possibly due to chronic granulomatous infections such as tuberculosis or histoplasmosis or antigen-antibody complexes so that this immune response may result in deposition of immunoglobulins or immune complexes in the lung [1][2][3][4][5][6][7][8]. A patient with suspected lung cancer was diagnosed pulmonary hyalinizing granuloma by transthoracic fine needle aspiration (TTFNA).…”

“…Radiologically single or multiple nodules between 0.2-15 cm are often, may be unilateral or bilateral and any lobe of the lung could be involved [2,4,6,11,12]. Therefore PHG should not only be considered in patients showing multiple pulmonary nodules but also in patients showing solitary nodules.…”

“…F-18 fluordeoxyglucose positron emission tomography (FDG-PET/CT) can reveal increased metabolic activity in PHG lesions [6]. However, an accurate diagnosis of PHG can only be made with histopathological examination.…”

Calcified multinodular lung lesions: a broad differential diagnosis

“…Amyloidosis can be ruled out using electron microscopy. Although rare, cavitation has been reported (2,7). Epithelioid hemangioendothelioma is a rare endothelial tumor.…”