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Letters to the Editor

Indian Pediatrics 2004; 41:292-293

Plasma Cell Granuloma of the Lung


A 9-year-old girl presented with history of high-grade fever and cough for 2 months duration. She was thin built, febrile and had mild pallor. Systemic examination revealed dullness and decreased breath sounds in right infraclavicular region. Other systems were normal. Chest skiagram revealed a rounded opacity in right upper lobe (Fig. 1). CT chest revealed a mass in right upper lobe. On thoracotomy there was a 6.5 -7 cm mass in the right upper lobe with few hilar nodes. Right upper lobectomy was done and the mass was removed in toto. Cut section showed a well-demarcated pale white solid mass. Histo-pathological examination was suggestive of plasma cell granuloma.

Fig. 1. Chest X-ray showing a rounded
opacity in right upper lobe.

Plasma cell granuloma, an inflammatory pseudotumor is a non-neoplastic process characterized by unregulated growth of inflammatory cells. It is a rare lesion that usually presents as a solitary nodule, but may be multiple and involve more than one ipsilateral lobe or both the lungs in children(1). This is frequently seen in adults and occurs rarely in children younger than 10 years of age, however this is the most common benign lung mass in infant and children. Various terms like inflammatory myofibroblastic tumor, fibrous xanthoma, xanthogranuloma, xanthofibroma, histiocytoma and fibrous histiocytoma are used based on predominant cell type and stroma. The pathogenesis is not clear, but is considered as a reparative process of an inflammatory lung lesion. Most of them are asymptomatic at the time of presentation, but some may have symptoms like fever, chest pain, cough, hemoptysis, airway obstruction and dysphagia due to esophageal obstruction. Deaths have been reported due to extrinsic compression of mediastinal structure(2,3). In chest radiograph, CT or MR imaging, the lesion usually appears as a well-defined solitary parenchymal nodules(3), rarely as ill-defined mass and occasionally cavitation may occur. Right lung is more commonly affected and the size can vary from 0.5 to 36 cm. Plasma cell granulomas are non-neoplastic and often locally invades the mediastinum, diaphragm, chest wall, vertebral bodies and major vessels(1). Primary hilar adenopathy may also be present, however metastatic spread has not been reported. The natural course is usually either a slow growth or spontaneous resolution. As preoperative imaging and intraoperative biopsy are indistinguishable from that of malignancy, surgical resection of the mass or lobectomy is done depending on diagnostic uncertainty and anatomical position. Diagnosis is usually confirmed by frozen section biopsy. Histo-pathologically, pulmonary pseudotumor demonstrates a mixed inflammatory infiltrate with a preponderance of plasma cells; evaluation shows varieties of inflammatory cells including lymphocytes, fat laden macro-phages and other types of lung parenchymal cells. Recurrences after resection are rare but have been reported(2). Although benign, they have the capacity for local invasion; rapid growth and few of these tumors are also known to undergo sarcomatous transformation(4).

A. Balachandran,
So. Shivbalan,

Kanchi Kamakoti CHILDS Trust Hospital,
12-1, Nageswara Road, Nungambakkam,
Chennai 600 034, India.
E-mail: dr_abalachandran@hotmail.com

References

1. Singh RS, Dhaliwal RS, Puri D, Behera D, Das A. Inflammatory pseudotumor of the lung: Report of a case and review of literature. Indian J Chest Dis Allied Sci 2001; 43: 231.

2. Shochat S. Tumors of the Lung. In: Oneill JA, Rowe MI, Grosfeld JL, Funkalsrud EW, Coran AG, editors. Pediatric Surgery Volume 1.5th ed. Mosby; St. Louis, Newyork, London, Toronto, 1998. p 921-925.

3. Oldham KT. Lungs. In: Oldham KT, Colombani PM, Forglia RP, editors. Surgery of Infants and Children-Scientific Principle and Practices. 1st ed. Lippincott-Raven publisher; Philadelphia, Newyork, 1997. p. 935-970.

4. Bahadori M, Liebow AA. Plasma cell granu-lomas of the lung. Cancer 1973; 31: 191-208.


 

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