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LETTER TO EDITOR
Year : 2014  |  Volume : 31  |  Issue : 3  |  Page : 307-308  

Spontaneous resolution of pulmonary inflammatory pseudotumor


Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

Date of Web Publication1-Jul-2014

Correspondence Address:
Ashok Shah
Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.135797

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How to cite this article:
Shah A, Gupta UA. Spontaneous resolution of pulmonary inflammatory pseudotumor. Lung India 2014;31:307-8

How to cite this URL:
Shah A, Gupta UA. Spontaneous resolution of pulmonary inflammatory pseudotumor. Lung India [serial online] 2014 [cited 2021 Apr 12];31:307-8. Available from: https://www.lungindia.com/text.asp?2014/31/3/307/135797

Sir,

We read with interest the case report by Swathi et al. [1] entitled "Pleural effusion masquerading as pseudotumor" wherein they state "Unlike the vanishing tumor of heart failure which resolves spontaneously, pulmonary inflammatory tumors need surgical excision". We would like to highlight the literature on the subject and submit that pulmonary inflammatory pseudotumor (IPT) may exhibit spontaneous resolution.

We reported [2] a 44-year-old male, who presented to us with cough and minimal expectoration for five months, along with chest pain, hemoptysis and fever for a fortnight. Imaging revealed an irregular mass in the right middle lobe and biopsy showed plasma cell granuloma. The patient underwent surgery to remove the mass but resection had to be abandoned as the mass was adherent to the lower lobe, chest wall and mediastinum. However, a wedge biopsy confirmed the diagnosis of pulmonary IPT. Remarkably, the patient experienced marked symptomatic relief within three weeks, significant resolution on chest radiograph at four weeks, and complete resolution with residual scar on computed tomographic scan done at 1 year. [2]

While reviewing the literature for pulmonary IPT, we found five reports documenting a total of 6 patients with spontaneous resolution of pulmonary IPT, with ours being the seventh such patient. Pulmonary IPT presented as a mass in 5 patients. In another set of 5/7 patients, invasive diagnostic procedure was followed by complete spontaneous resolution of symptoms by four weeks to three months. We also found in the literature reports of two patients with pulmonary IPT, in whom spontaneous reduction in tumor size without complete resolution was documented. [3],[4]

Complete spontaneous resolution has been reported for extra-pulmonary IPT also. In one patient, an IPT of liver resolved completely spontaneously, after diagnostic biopsy. [5] In another patient with a mass in the base of skull anteriorly, slow but complete spontaneous resolution was reported. [6] Complete resolution of pulmonary IPT has also been reported when corticosteroids were given for co-existent inflammatory tumorous lesions in other organs- intracranial cavernous sinus, [7] pituitary stalk and other sites, [8] and kidney and other organs. [9]

Overall, prevalence of IPT is estimated to be 0.7% in tumors of lung and bronchi. [10] It displays local aggression and hence it has been christened 'tumor' but it has an encouraging prognosis, hence it is also called 'pseudotumor'. Perhaps the best name that summarizes its characteristics is given by Umiker and Iverson [11] who called it 'post inflammatory pseudo tumor'. In conclusion, it appears that pulmonary IPT can undergo spontaneous resolution, especially after invasive diagnostic procedure.

 
   References Top

1.Swathi P, Chandhar S, Bhaskar E, Rajarajan R. Pleural effusion masquerading as pseudotumor. Lung India 2014;31:86-7.  Back to cited text no. 1
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2.Maurya V, Gupta UA, Dewan RK, Jain S, Shah A. Spontaneous resolution of an inflammatory pseudotumour of the lung subsequent to wedge biopsy. Arch Bronconeumol 2013;49:31-4.  Back to cited text no. 2
    
3.Mandelbaum I, Brashear RE, Hull MT. Surgical treatment and course of pulmonary pseudotumor (plasma cell granuloma). J Thorac Cardiovasc Surg 1981;82:77-82.  Back to cited text no. 3
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4.Bush A, Sheppard MN, Wahn U, Warner JO. Spontaneous arrest of growth of a plasma cell granuloma. Respir Med 1992;86:161-4.  Back to cited text no. 4
    
5.Nakama T, Hayashi K, Komada N, Ochiai T, Hori T, Shioiri S, et al. Inflammatory pseudotumor of the liver diagnosed by needle liver biopsy under ultrasonographic tomography guidance. J Gastroenterol 2000;35:641-5.  Back to cited text no. 5
    
6.Katoh M, Imamura H, Yoshino M, Aoki T, Abumiya T, Aida T. Spontaneous regression of an anterior skull base mass. J Clin Neurosci 2010;17:786-8.  Back to cited text no. 6
    
7.Konishi H, Ookuma H, Hara H, Okayasu H, Wakayama Y, Saiki S.A case of plasma cell granuloma associated with cerebral infarction. Rinsho Shinkeigaku 1996;36:854-7.  Back to cited text no. 7
    
8.Tsuboi H, Inokuma S, Setoguchi K, Shuji S, Hagino N, Tanaka Y, et al. Inflammatory pseudotumors in multiple organs associated with elevated serum IgG4 level: Recovery by only a small replacement dose of steroid. Intern Med 2008;47:1139-42.  Back to cited text no. 8
    
9.Dhobale S, Bedetti C, Killian P, Ilyas M, Liput J, Jasnosz K, et al. IgG4 related sclerosing disease with multiple organ involvements and response to corticosteroid treatment. J Clin Rheumatol 2009;15:354-7.  Back to cited text no. 9
    
10.Golbert SV, Pletnev SD. On pulmonary "pseudotumours". Neoplasma 1967;14:189-98.  Back to cited text no. 10
    
11.Umiker WO, Iverson L. Post inflammatory tumor of the lung; report of four cases simulating xanthoma, fibroma, or plasma cell tumor. J Thorac Surg 1954;28:55-63.  Back to cited text no. 11
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