Diagnostic approach to localised organising pneumonia – A case report
Abstract
Introduction. Localised organising pneumonia, radiologically presented with oval or round shadows mimicing lung cancer or metastases, is a major issue in differential diagnosis. Case report. A female patient was hospitalized to clarified the etiology of multiple nodular lung lesions. The chest X-ray and the chest computed tomography (CT) revealed bilateral patchy and nodular shadows, and round lung lesions, respectively. Neither sputum analyses, nor histology of bronchoscopy samples clarified the etiology of these lung lesions. As secondary deposits in the lungs were suspected, video-assisted thoracoscopy and anterolateral right minithoracotomy with atypical upper and lower lobe resection were performed. The frozen-section analysis suggested the benign nature of the lesion, and the definite histopathological finding of localised organising pneumonia was established. Due to bilateral lung lesions, corticosteroids were applied. Seven weeks later, the chest CT finding revealed a total regression of the lesions. Conclusion. A surgical resection was necessary to diagnose the localised organising pneumonia which mimiced secondary malignant lesions, thus establishing the definite etiology of lung lesions. Bronchoscopic cryobiopsy, recently introduced in order to obtain peripheral lung biopsy samples, has provided new possibilities in the diagnosis and treatment of neoplastic and non-neoplastic lung diseases.
References
Cordier JF. Organising pneumonia. Thorax 2000; 55(4): 318−28.
Cordier JF. Cryptogenic organising pneumonia. Eur Respir J 2006; 28(2): 422−46.
Yang PS, Lee KS, Han J, Kim EA, Kim TS, Choo IW. Focal or-ganizing pneumonia: CT and pathologic findings. J Korean Med Sci 2001; 16(5): 573−8.
Furuya K, Yasumori K, Takeo S, Sakino I, Uesugi N, Momosaki S, Muranaka T. Lung CT: Part 1, Mimickers of lung cancer--spectrum of CT findings with pathologic correlation. AJR Am J Roentgenol 2012; 199(4): W454−63.
Alikhan M, Veeraghavan S. Empiric Treatment of Focal Organ-izing Pneumonia in a Patient with a Low - Risk Lung Mass. Case Rep Pulmonol 2013; 2013: 340202.
Kevin OL, Mark RW. Practical Pulmonary Pathology A diag-nostic approach. 2nd ed. St. Louis, Mo: Elsevier Saunders; 2005.
Travis WD, Costabel U, Hansell DM, King TE, Lynch DA, Nichol-son AG, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013; 188(6): 733−48.
Kropski JA, Pritchett JM, Mason WR, Sivarajan L, Gleaves LA, Johnson JE, et al. Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease. PLoS One 2013; 8(11): e78674.
Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P, Balli T, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Res-piration 2009; 78(2): 203−8.
Casoni GL, Tomassetti S, Cavazza A, Colby TV, Dubini A, Ryu JH, et al. Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS ONE 2014; 9(2): e86716.
Griff S, Ammenwerth W, Schonfeld N, Bauer TT, Mairinger T, Blum TG et al. Morphometrical analysis of transbronchial cryobiop-sies. Diagn Pathol 2011; 6: 53.
Schuhmann M, Bostanci K, Bugalho A, Warth A, Schnabel PA, Herth FJ, et al. Endobronchial ultrasound-guided cryobiopsies in peripheral pulmonary lesions: a feasibility study. Eur Respir J 2014; 43(1): 233−9.
Wu CT, Chang YL, Chen WC, Lee YC. Surgical treatment of or-ganising pneumonia mimicking lung cancer: experience of 27 patients. Eur J Cardiothorac Surg 2010; 37(4): 797−801.
Maldonado F, Daniels CE, Hoffman EA, Yi ES, Ryu JH. Focal organizing pneumonia on surgical lung biopsy: causes, clinico-radiologic features, and outcomes. Chest 2007; 132(5): 1579−83.
Melloni G, Cremona G, Bandiera A, Arrigoni G, Rizzo N, Varagona R, et al. Localized organizing pneumonia: report of 21 cases. Ann Thorac Surg 2007; 83(6): 1946−51.
Maldonado F, Daniels CE, Hoffman EA, Yi ES, Ryu JH. Focal organizing pneumonia on surgical lung biopsy: causes, clinico-radiologic features, and outcomes. Chest 2007; 132(5): 1579−83.
Zheng Z, Pan Y, Song C, Wei H, Wu S, Wei X, et al. Focal organ-izing pneumonia mimicking lung cancer: a surgeon's view. Am Surg 2012; 78(1): 133−7.
Drakopanagiotakis F, Polychronopoulos V, Judson MA. Organizing pneumonia. Am J Med Sci 2008; 335(1): 34−9.
Yoo J, Song JW, Jang SJ, Lee CK, Kim M, Lee H, et al. Compari-son between cryptogenic organizing pneumonia and connec-tive tissue disease-related organizing pneumonia. Rheumatolo-gy 2011; 50(5): 932-8.