Abstract
Pulmonary ossifications have often been regarded as rare, post-mortem findings without any clinical significance. We have investigated the occurrence of pulmonary ossifications in patients undergoing thoracic procedures, and how this may affect the differential diagnosis of solitary pulmonary nodules. In addition, we have performed a literature search on the occurrence and possible pathogenesis of these ossifications. From January 2008 until August 2019, we identified pulmonary ossifications in 34 patients who underwent elective pulmonary surgery. Pre-operative imaging was unable to differentiate these ossifications from solid tumors. A definitive diagnosis was made by an experienced pathologist (VS, ML). The PubMed database was researched in December 2019 with the search terms “pulmonary ossifications”; “heterotopic ossifications”; and “solitary pulmonary nodule”. In total, 27 patients were male, with a mean age of 63 ± 12 years (age 41 to 82 on diagnosis). All lesions were identified on thoracic CT and marked for resection by a multidisciplinary team. A total of 17 patients were diagnosed with malignancy concurrent with ossifications. There was a clear predilection for the right lower lobe (12 cases, 35.3%) and most ossifications had a nodular form (70.6%). We could not identify a clear association with any other pathology, either cancerous or non-cancerous in origin. Oncologic or pulmonary comorbidities did not influence patient survival. Pulmonary ossifications are not as seldom as thought and are not just a curiosity finding by pathologists. These formations may be mistaken for a malignant space-occupying lesion, both pre-and perioperatively, as they are indistinguishable in imaging. We propose these ossifications as an underestimated addition to the differential diagnosis of a solitary pulmonary nodule.
Highlights
Mature bone tissue in the alveolar or interstitial spaces is a remarkable finding that was first described in an obduction report by the anatomist Herbert Von Luschka in 1856 [1].These pulmonary ossifications (PO) are occasionally found in the lung parenchyma of patients undergoing a thoracotomy for a solitary pulmonary nodule (SPN)
PO case series are often reported by pathologists as a curiosity finding post-mortem, we argue that pulmonary ossifications are more commonly observed than often thought, and are clinically relevant to the surgeon, radiologist, and pathologist alike
A total of 34 cases were identified from the period 2008–2019, with an average incidence of 1.1% to a total of 3122 thoracotomies or thoracoscopies performed at our center during this period
Summary
Mature bone tissue in the alveolar or interstitial spaces is a remarkable finding that was first described in an obduction report by the anatomist Herbert Von Luschka in 1856 [1]. These pulmonary ossifications (PO) are occasionally found in the lung parenchyma of patients undergoing a thoracotomy for a solitary pulmonary nodule (SPN). The pathogenesis of this phenomenon is not completely elucidated yet.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
