Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause?

Halide Nur Urer,Nurcan Unver,Mehmet Zeki Gunluoglu,Mediha Gonenc Ortakoylu,Sezer Toprak

doi:10.1155/2020/7850750

Halide Nur Urer, Nurcan Unver + Show 3 more

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https://doi.org/10.1155/2020/7850750

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Abstract

Aims We investigated the histopathological features of solitary pulmonary necrotic nodules (NNs) of undetermined cause. We combined our findings with those obtained using other methods to determine how well the etiological factors were explained. Methods We screened patients who underwent surgery to treat solitary pulmonary granulomatous and nongranulomatous NNs of undetermined cause. The NN sizes and features of both the NNs and adjacent parenchyma were evaluated. Histochemical analyses included Ehrlich–Ziehl–Neelsen (EZN), Grocott, and Gram staining. Polymerase chain reaction (PCR) was used to detect tuberculous and nontuberculous mycobacteria, panfungal DNA, Nocardia, Francisella tularensis types A and B, and actinomycetes. Results The NNs were granulomatous in 78.9% and nongranulomatous in 21% of the 114 patients included. EZN staining or PCR was positive for Mycobacterium in 53.5% of all NNs: 62.2% of granulomatous and 20.8% of nongranulomatous NNs. We found a weak but significant correlation between granulomatous NNs and Bacillus positivity and a significant correlation between granulomas surrounding the NNs and the presence of multiple necroses. The NN etiology was determined via histopathological, histochemical, and PCR analyses in 57% of patients but remained undetermined in 42.9%. Conclusion The causes of both granulomatous and nongranulomatous NNs can be determined by pathological examination. Granulomatous necrosis and granulomas in the adjacent parenchyma are important for differential diagnosis. When both features are present, they strongly support a diagnosis of tuberculosis, even in the absence of bacilli.

Highlights

Pulmonary necrotic nodules (NNs) are space-occupying lung lesions. e principal etiologies include infection, collagen tissue disease, thromboembolism, vasculitis, and aspiration
Cases of benign pulmonary NNs and granulomatous NNs treated between January 1, 2015, and December 31, 2017, in the Pathology Department of Yedikule Pulmonary Diseases and oracic Surgery Training and Research Hospital were screened
We examined 162 patients with benign NNs

Summary

Introduction

Pulmonary necrotic nodules (NNs) are space-occupying lung lesions. e principal etiologies include infection, collagen tissue disease, thromboembolism, vasculitis, and aspiration. Pulmonary necrotic nodules (NNs) are space-occupying lung lesions. E principal etiologies include infection, collagen tissue disease, thromboembolism, vasculitis, and aspiration. NNs are often difficult to distinguish from malignancies on clinical examination and radiological imaging. E underlying cause of pulmonary NNs can sometimes be determined based on morphology. Identification of an infectious agent facilitates diagnosis. The causes of some benign pulmonary nodules cannot be determined. We explored how often the etiological factors can be identified. E diagnostic and histopathological characteristics of the lesions were defined and evaluated in combination with histochemical and polymerase chain reaction (PCR) analyses We explored how often the etiological factors can be identified. e diagnostic and histopathological characteristics of the lesions were defined and evaluated in combination with histochemical and polymerase chain reaction (PCR) analyses

Materials and Methods

Results

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