Abstract
BackgroundOrganizing pneumonia (OP) is a rare disease that is often easily misdiagnosed as a malignancy. The diagnosis of OP can prove quite challenging. Patients typically receive treatment with high-dose corticosteroids. Relapse is common if corticosteroid treatment is reduced or stopped. However, given that long-term corticosteroid treatment often results in significant side-effects, the aim of this study was to discuss the diagnosis and surgical treatment of OP.Material and methodsThe medical records of 24 patients with pathologically diagnosed OP between October 2007 and January 2019 were retrospectively reviewed. All patients underwent thoracic computed tomography (CT) and transbronchial biopsy or CT-guided percutaneous needle aspiration. We analysed the clinical manifestations, radiological findings, diagnostic methods, treatment, and follow-up outcomes of all patients.ResultsIn total, 24 patients with OP were identified. The study included 17 (70.8%) men and 7 (29.2%) women, and the mean age was 61.25 ± 11.33 years (range: 31–82). The most common symptom was cough (n = 16; 66.6%), and the most common radiological finding was consolidation (n = 13; 54.2%) on thoracic CT. The diagnosis of OP was made by transbronchial biopsy in 11 patients (45.8%), and percutaneous needle aspiration biopsy in 13 (54.2%). We performed 11 wedge resections, 9 segmentectomy, and 4 lobectomies. Twenty patients underwent video-assisted thoracoscopic surgery (VATS), and 4 underwent thoracotomy. Complete lesion resection was obtained in all patients, and all patients were discharged from the hospital between 5 and 11 days after surgery. The mean follow-up period was 59.1 ± 34.5 (range: 2–134) months. Residual lesions or local or distant recurrence were not observed.ConclusionsOP is a rare disease, and the exact aetiology remains unclear. Preoperative diagnosis is difficult to achieve despite the use of transbronchial biopsy or CT-guided percutaneous needle aspiration. Complete surgical resection represents an effective method for the treatment of OP.
Highlights
Organizing pneumonia (OP) is a common histopathological response to injury in the lung, demonstrating inflammatory intra-alveolar infiltration that leads to fibrosis on pathology [1]
Complete lesion resection was obtained in all patients, and all patients were discharged from the hospital between 5 and 11 days after surgery
Preoperative diagnosis is difficult to achieve despite the use of transbronchial biopsy or computed tomography (CT)-guided percutaneous needle aspiration
Summary
Organizing pneumonia (OP) is a common histopathological response to injury in the lung, demonstrating inflammatory intra-alveolar infiltration that leads to fibrosis on pathology [1]. OP can be primary or secondary to some clinical situations. The histopathological pattern of OP typically reveals granulation tissue plugs within the alveoli, alveolar ducts, and small airways (Masson bodies) [2, 4] These inflammatory tissue plugs occlude the distal bronchioles and previously described bronchiolitis obliterans OP. Corticosteroids represent the main treatment for OP, but relapses are common after reducing or stopping treatment [8,9,10]. In this retrospective study, we aimed to report the experience on the surgical management of OP patients. Given that long-term corticosteroid treatment often results in significant side-effects, the aim of this study was to discuss the diagnosis and surgical treatment of OP
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