A 41-year-old female, during a routine physical examination at the unit, found an 8 mm nodule on chest CT. From the image, the nodule has burrs, lobes, and pleural stretching. Because it is a solid nodule and is close to the pleura, it may develop rapidly if it is malignant. However, the nodule was too small to puncture, so the local hospital doctor recommended direct surgical removal. However, when the pathological results came out, the patient was happy and worried, and the joy was that the pathology was an inflammatory pseudoma, not lung cancer. Worryingly, the removal of part of the lungs because of benign nodules seems to be a bit more than worth the loss.
The disease of inflammatory pseudotumor has been talked about many times before, as the name suggests, it is a tumor-shaped nodule or lump formed by inflammation, not a real tumor. It can only be regarded as a benign disease, a chronic, non-specific, proliferative inflammation, so it is not even a benign tumor. When there is an inflammatory infection in the lungs, some can be completely absorbed, and some cannot be absorbed to form scar tissue, which is manifested as fibrous cord shadow and calcified foci. Some chronic inflammation gradually produces granulomas and chronic proliferation, forming a nodule or lump shape in the lungs, which is an inflammatory pseudotumor.
Inflammatory pseudotumors can occur in both men and women, more common over 40 years old, usually the right lung is the majority, most of the inflammatory pseudotumors are asymptomatic. A small number of patients with large inflammatory pseudotumors and poor positions near the lung gate will have low-grade fever, chest pain, cough, sputum cough, sputum with blood and other similar lung cancer manifestations.
Why are inflammatory pseudotumors mistaken for lung cancer and operated on?
The main reason is that imaging inflammatory pseudotumors are very similar to lung cancer. On CT, inflammatory pseudotumors can also show soft tissue density shadows, and there are also malignant signs such as lobes, burrs, vascular connections, and cavities, and even enhanced scanning. Some inflammatory pseudotumor lesions are located around the hilars and are similar to central lung cancers, so they are sometimes difficult to distinguish and distinguish by CT alone.
Theoretically, for lesions with high suspicion of malignancy, routine lung puncture or tracheoscopy is recommended to clarify the pathology. However, some lesions are too small to puncture, and some patients are impatient and require surgery as soon as possible but have heart disease, and for various reasons, a very small number of patients suspect that malignancy but surgical pathology is a benign disease every year.
Inflammatory pseudotumors are proliferative foci of chronic inflammatory formation, and in general, once a pseudotumor is formed, the likelihood of complete disappearance by anti-inflammatory therapy is extremely small. The probability of malignancy of inflammatory pseudotumors is also extremely low and negligible. Therefore, if the patient has no symptoms, the lesion is relatively small, and the morphology has not changed during the follow-up, at this time, no treatment can be required, and long-term follow-up can be continued. Surgical resection is advocated for the presence of symptoms such as fever, cough, sputum production, or if the lesion is large and compresses the surrounding lung tissue.
When CT imaging suspects malignancy but cannot determine whether it is an inflammatory pseudoma or lung cancer, it is recommended to perform a lung puncture or bronchoscopic biopsy to confirm the pathology. If pathological examination results confirm that the pneumonic pseudotumor is present, as much normal tissue as possible should be preserved without the need for lobectomy.