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"Doctor, could the 3cm nodule in my lungs be benign?"
During today's rounds, a patient asked me this question. He told me that he had learned from some reports that the smaller the lung nodule, the more likely it was to be benign. However, his nodules are 3 centimeters in size, and even slightly larger ones would be called lung tumors. So, is it possible that this situation is benign? This question became his doubt.
With the popularity of health checkups, more and more lung nodules have been found. One of the biggest concerns is whether these nodules are benign or malignant and whether surgical intervention is required.
For lung nodules a few millimeters in size, we generally recommend clinical observation. However, surgical intervention may need to be considered when the nodule diameter exceeds 8 mm and the imaging diagnosis is poor.
Going back to the patient just mentioned, his nodule is located in the dorsal segment of the lower lobe of the right lung. Due to a cough accompanied by hemoptysis, he was admitted to the respiratory medicine department. During his hospitalization, his markers of inflammation and tuberculosis were normal. Imaging shows burrs on nodules and traction with the pleura. The patient was emotionally disturbed and eventually decided to undergo surgery.
After the surgery cut open the lung, a stench quickly filled the entire operating room. When the chest cavity is opened, adhesions between the lower lobe of the right lung and the diaphragm and mediastinal surface are found to be very severe. After separating the adhesions, doctors perform a wedge resection of the lower right lung nodule. There is a hard lump in the center of the removed lung tissue. The surgeon picks up the scalpel blade and cuts the lump straight through.
As soon as the surface of the lung was cut, an unpleasant stench immediately came to the nose, and the entire operating room was instantly filled with a pungent smell. Although I have not yet seen the specific shape of the lump, the corners of the surgeon's mouth have risen slightly, and he said: "Such a smell, it should be a benign, inflammatory pseudotumor." ”
After about 30 minutes, the results of a rapid pathological examination came out, and sure enough, it was confirmed to be an inflammatory pseudotumor. This means that the surgery can be ended early.
So, what is a pneumonic pseudotumor?
Although the name contains "inflammatory" and "pseudotumor", strictly speaking, pneumonic pseudotumor is not a real tumor, but a benign hyperplastic lesion caused by inflammation. In other words, it does not have the characteristics of a malignant tumor. And this inflammation is precisely what causes its formation. It is worth noting that pneumonic pseudotumors rank first among all benign tumors of the lung.
Why does inflammatory pseudotumor fill the entire operating room with a foul smell?
Because inflammatory pseudotumors are usually caused by inflammation, patients often have manifestations of chronic inflammation. As bacteria multiply, so do their metabolites, resulting in a variety of unpleasant odors. In fact, the bacteria themselves do not have a noticeable odor, and the smell we smell is often the result of bacterial metabolites. This also explains why the smell of "rotten eggs" is smelled on the operating table, and the surgeon suddenly asserts that it is an "inflammatory pseudotumor".
When is pneumonic pseudotumor suspected?
Diagnosis and differentiation of pneumonic pseudotumors is relatively difficult. First, some patients may have no obvious symptoms but are discovered incidentally during a physical examination. Other patients may have symptoms such as cough, sputum production, and hemoptysis. As mentioned in the text, he found lung nodules due to coughing with hemoptysis. It is important to note that pneumonic pseudotumors behave clinically and radiographically very similarly to lung cancer compared to other types of nodules, sometimes even producing discharge or causing pleural traction. Especially when the nodule is large, the diagnosis can only be confirmed by surgical removal.
Summary:
Benign and malignant pulmonary nodules are an important problem for both patients and doctors. Although there is an association between nodule size and the likelihood of benignness, benign nodules can also be achieved
Quite large size. Therefore, when judging the nature of lung nodules, it is not only dependent on size, but also needs to combine clinical symptoms, imaging features and pathological examination.
For doctors, this is a challenge that requires careful analysis and judgment. As the surgeon's clinical experience during surgery has shown, flexible thinking and keen observation are required even in lung nodule removal surgery. From the foul smell smelled during the operation, combined with the patient's clinical manifestations, the doctor was able to accurately determine that this was an inflammatory pseudotumor, thus avoiding unnecessary surgical risks and trauma.
Although pneumonic pseudotumor is benign, it is also a reminder that inflammation can trigger a variety of different reactions inside the body. When we smell a foul smell, we are actually feeling the presence of bacterial metabolites, which is an important clue in medicine to help doctors make the correct diagnosis. Moreover, the discovery of pneumonic pseudotumor once again proves the complex relationship between inflammation and tumor, and provides new ideas and directions for tumor research.
In medicine, every case is a story and every surgery is a challenge. From the story of inflammatory pseudotumor, we see the professionalism and continuous innovation spirit of doctors. Whether from the patient's perspective or the doctor's point of view, every breakthrough and success deserves our deep consideration and admiration.
In the future, with the continuous advancement of medical technology, we have reason to believe that the diagnosis and treatment of lung nodules will become more accurate and effective. In this process, the doctor's clinical experience and scientific research results will continue to bring health and hope to patients.
As a thoracic surgeon, I will continue to devote myself to using clinical cases to popularize health knowledge and become a health assistant around everyone. If this article can help you, welcome to like and share it with those who need it, so that more people can benefit.
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