Pulmonary mass: never judge a book by its cover

De haes, Inke; Valcke, Yvan; Deschepper, Koen; Beerens, Elisabeth; Goeminne, Pieter

doi:10.1007/S12254-018-0404-2

Title

Pulmonary mass: never judge a book by its cover

Author

De haes, Inke

Valcke, Yvan

Deschepper, Koen

Beerens, Elisabeth

Goeminne, Pieter

Abstract

This case shows that a tumor can present in an uncommon way. When dealing with pulmonary masses, tissue remains the most important issue. We present the case of a 71-year-old woman with a mass of more than 10 cm in the left lung. Pulmonary CT scan and PET scan confirmed this with also revealing mediastinal, thoracic and paravertebral invasion, without extrathoracic metastatic lesions. Bronchoscopic evaluation and ultrasound guided transbronchial needle aspiration could not yield a diagnosis. Because of rapid clinical deterioration, new imaging was performed, showing a cavitary lesion with air-fluid level in the tumor. Extensive microbiological work-up remained negative. To yield a pathological diagnosis, we performed a thoracotomy, revealing a polymorphic lymphoid infiltrate with scattered large atypical B-cells infected with Epstein-Barr virus, vasculitis and granulomatosis leading to a diagnosis of Lymphomatoid Granulomatosis. The patient received 6 cycles of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Methylprednisolone), 2 doses of Rituximab monotherapy, 4 doses of intrathecal Methotrexate and consolidation radiotherapy with a complete response. Lymphomatoid granulomatosis (LYG) is a rare pulmonary disease, which should be included in the differential diagnosis of 'a pulmonary mass'. This case emphasizes the need for tissue acquisition.

Language

English

Source (journal)

memo - Magazine of European Medical Oncology

Publication

2018

ISSN

1865-5041

DOI

10.1007/S12254-018-0404-2

Volume/pages

11 :2 (2018) , p. 158-160