Pulmonary Inflammatory Pseudotumor Research Articles

Diagnostic Performance of 18 F-FDG Positron Emission Tomography/Computed Tomography and Blood Test Parameters for Pulmonary Inflammatory Pseudotumor.

Pulmonary inflammatory pseudotumor (PIP) is an inflammatory proliferative tumor-like lesion that frequently exhibits hypermetabolism on 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography imaging (PET/CT) and is readily misdiagnosed as a malignant tumor. The purpose of this study was to identify PIP by combining PET/computed tomography metabolic and blood test characteristics with machine learning. We recruited 27 patients with PIP and 28 patients with lung cancer (LC). The PET metabolic and blood test parameters were collected, and the differences between the groups were evaluated. In addition, we combined the support vector machine (SVM) classifier with the indicators that differed between the groups to classify PIP and LC. For PET metabolic parameters, our findings showed that, as compared with the LC group, maximal standardized uptake value ( P < 0.001, t = -4.780), Mean standardized uptake value SUV mean , P < 0.001, t = -4.946), and SD40% ( P < 0.001, t = -4.893) were considerably reduced in the PIP group, whereas CV40% ( P = 0.004, t = 3.012) was significantly greater. For blood test parameters, the total white blood cell count ( P < 0.001, t = 6.457) and absolute neutrophil count ( P < 0.001, t = 6.992) were substantially higher in the PIP group than in the LC group. Furthermore, the performance of SVM trained solely on PET metabolic parameters (mean area under the curve [AUC] = 0.84) was comparable to that of SVM trained solely on blood test parameters (mean AUC = 0.86). Surprisingly, utilizing the combined parameters increased SVM performance significantly (mean AUC = 0.98). PET metabolic and blood test parameters differed significantly between the PIP and LC groups, and the SVM paradigm using these significantly different features has the potential to be used to classify PIP and LC, which has important clinical implications.

Computed Tomography-Based Radiomics Analysis of Different Machine Learning Approaches for Differentiating Pulmonary Sarcomatoid Carcinoma and Pulmonary Inflammatory Pseudotumor

Background: Differentiating between pulmonary sarcomatoid carcinoma (PSC) and pulmonary inflammatory pseudotumor (PIP) is challenging using current conventional diagnostic methods. This lack of distinction significantly impacts subsequent clinical treatment decisions. Objectives: This study was conducted to construct an effective method to distinguish between PSC and PIP based on commonly used computed tomography (CT) images. Patients and Methods: A total of 14 patients with PSC and 76 patients with PIP were retrospectively included in the study for CT imaging. Radiomics features were extracted from non-enhanced CT images, and canonical correlation analysis was performed to reduce redundancy. The final radiomics signature was then identified using the least absolute shrinkage and selection operator (LASSO). Logistic regression (LR), classification and regression trees (CART), support vector machine (SVM), k-nearest neighbors (KNN), and gradient boosting machine (GBM) were used to construct the radiomics models. The performance of these different radiomics models was evaluated using the receiver operating characteristic curve. Results: A total of 1186 radiomics features were extracted from non-enhanced CT images. After dimensionality reduction and selection, 7 valuable features were identified. The performance of 5 machine learning models was evaluated to differentiate between PSC and PIP, and the GBM-based radiomics model demonstrated the best performance. The GBM-based radiomics model achieved an accuracy of 0.922, area under the curve (AUC) of 0.98, F1 score of 0.967, and log loss of 0.161. Compared to conventional clinical-radiological diagnosis, the GBM-based radiomics model showed a significant association (odds ratio [OR] = 8.119; P = 0.006). Conclusion: The implementation of the GBM-based radiomics model has the potential to improve the ability to differentiate between PSC and PIP, thereby influencing the timeliness of subsequent surgical interventions and even the prognosis of patients.

Pulmonary inflammatory pseudo tumor in a severe superimposed pneumonia patient with Sars-Cov-2

Pulmonary inflammatory pseudo tumor in a severe superimposed pneumonia patient with Sars-Cov-2

Using CT texture analysis to differentiate between peripheral lung cancer and pulmonary inflammatory pseudotumor

BackgroundThis study is to distinguish peripheral lung cancer and pulmonary inflammatory pseudotumor using CT-radiomics features extracted from PET/CT images.MethodsIn this study, the standard 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (18 F-FDG PET/CT) images of 21 patients with pulmonary inflammatory pseudotumor (PIPT) and 21 patients with peripheral lung cancer were retrospectively collected. The dataset was used to extract CT-radiomics features from regions of interest (ROI), The intra-class correlation coefficient (ICC) was used to screen the robust feature from all the radiomic features. Using, then, statistical methods to screen CT-radiomics features, which could distinguish peripheral lung cancer and PIPT. And the ability of radiomics features distinguished peripheral lung cancer and PIPT was estimated by receiver operating characteristic (ROC) curve and compared by the Delong test.ResultsA total of 435 radiomics features were extracted, of which 361 features showed relatively good repeatability (ICC ≥ 0.6). 20 features showed the ability to distinguish peripheral lung cancer from PIPT. these features were seen in 14 of 330 Gray-Level Co-occurrence Matrix features, 1 of 49 Intensity Histogram features, 5 of 18 Shape features. The area under the curves (AUC) of these features were 0.731 ± 0.075, 0.717, 0.748 ± 0.038, respectively. The P values of statistical differences among ROC were 0.0499 (F9, F20), 0.0472 (F10, F11) and 0.0145 (F11, Mean4). The discrimination ability of forming new features (Parent Features) after averaging the features extracted at different angles and distances was moderate compared to the previous features (Child features).ConclusionRadiomics features extracted from non-contrast CT based on PET/CT images can help distinguish peripheral lung cancer and PIPT.

Case report of pulmonary inflammatory pseudotumor in children

Case report of pulmonary inflammatory pseudotumor in children

Pulmonary Inflammatory Pseudotumor and Skull Plasma Cell Granuloma as Metachronous Manifestations of IgG4-Related Disease

SESSION TITLE: Lung Pathology 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: IgG4 related disease is a recently identified entity that causes tumefactive lesions of organs due to lymphoplasmacytic infiltration by IgG4 positive plasma cells and leads to fibrosis. We present a young man with history of recurrent cryptogenic organizing pneumonia (COP) diagnosed retrospectively as inflammatory pseudotumor of the lung, after calvarial and meningeal plasma cell granuloma (PCG) diagnosis, both metachronous manifestations of IgG4 related disease. CASE PRESENTATION: A 28-year-old male presented to our hospital with seizures in 2016. MRI showed parietal and occipital calvarial lesions with meningeal enhancement that were resected. Biopsy showed spindle cell proliferation with mature polyclonal plasma cells and absence of ALK1 staining, consistent with PCG. IgG4 staining was positive. Computerized tomographic scan revealed chronic interstitial fibrotic changes in bilateral lung apices. On retrospective chart review, it was noted that he had presented with cough with interstitial infiltrates/fibrosis, fever and leukocytosis in 2014. At that time, an extensive infectious and connective tissue disease work up was negative and bone marrow aspiration and biopsy were normal. He was empirically treated with prednisone with subsequent resolution of symptoms. Earlier in 2009, he had presented to another hospital with fever and interstitial lung infiltrates and was treated as COP after lung biopsy. Reevaluation of the slides from 2009 biopsy was consistent with inflammatory pseudotumor of the organizing pneumonia, fibrohistiocytic type with predominant macrophages and fibrosis. DISCUSSION: Autoimmune pancreatitis was the first IgG4 disease to be characterized; however it can involve any organ. Organ involvement can be metachronous. Histopathological features of IgG4 related disease are dense lymphoplasmacytic infiltrate, storiform fibrosis and obliterative phlebitis. There is variability in findings in organs such as the lungs in which aggregates of neutrophils may be found within inflammatory infiltrates, with lack of storiform fibrosis in non-solid lesions such as interstitial pneumonia. Steroids are the first line of treatment, however patients may flare despite adequate treatment. Immunosuppressive drugs have been used as steroid-sparing agents and for maintenance therapy. Steroid-refractory disease and recurrent disease has been shown to have a good response to rituximab. Response to treatment is better during the lymphoplasmacytic infiltration stage, prior to extensive fibrosis. CONCLUSIONS: It is important to consider IgG4 related disease in tumors of any organ and if tissue biopsy is consistent with this diagnosis, extensive surgery can be avoided since the disease in the active phase responds to steroid or rituximab. Reference #1: “Inflammatory myofibroblastic tumor (plasma cell granuloma). Clinicopathologic study of 20 cases with immunohistochemical and ultrastructural observations.” Am J Clin Pathol 94(5): 538-546. DISCLOSURE: The following authors have nothing to disclose: Aditya Kotecha, Hussein Saleh, Saraschandra Vallabhajosyula, Christina Desousa, AbuFazl Mohammed, Vivek Iyer, Geetha Krishnamoorthy No Product/Research Disclosure Information

Pulmonary inflammatory myofibroblastic tumor versus IgG4-related inflammatory pseudotumor: differential diagnosis based on a case series.

Pulmonary inflammatory myofibroblastic tumor (IMT) has been considered as a synonym for inflammatory pseudotumor (IPT) for a long time. Recent studies have indicated that IMT and IgG4-related IPT are distinct diseases. However, no consensus criteria have been recommended. Here we propose a set of criteria for the differential diagnosis. Twenty-six archived IMT and IgG4-related IPT samples were examined for histological characteristics and the expression of IgG, IgG4, SMA and ALK-1. Based on our proposed criteria, we reclassified the cases into either IMT or IgG4-related IPT group and compared the clinicopathological features, laboratory findings, overall survivals (OS) and disease-free survivals between groups to validate the effectiveness and dependability of the diagnostic criteria. The average age of IgG4-related IPT group was higher than IMTs (48.82 vs. 39.22 years, P=0.031). In IMT group, tumors were characterized by bigger tumor sizes (3.47 vs. 2.22 cm, P=0.007), diffuse and total destroyed alveoli (88.89% vs. 17.65%, P=0.002), fewer lymphoid follicles (1.6/HPF vs. 3.0/HPF, P=0.045) and lower expression of IgG (74.7/HPF vs. 149.1/HPF; P<0.001). As an exclusion criterion of IgG4-related IPT, ALK-positivity was correlated with the higher cytological atypia (mean 3.7/HPF, P<0.001) and lesser lymphoid follicles (mean 1.2/HPF, P=0.021). And it's the first study to show the liner positive correlation between the lymphocytes + plasma cells count and IgG4-positive plasma cells count in these lesions (r=0.914, P<0.001). The negative correlation between the IgG4-positive plasma cells count and the expression of ALK-1 are reported for the first time as well (rs=-0.632, P=0.001). However, despite two patients with recurrence or metastasis were divided into IMT group, only borderline values were detected in the survival analysis (OS 88.89% vs. 100%, P=0.197, DFS 77.78% vs. 100.00%; P=0.056). The significant differences of clinicopathological characteristics between the IMTs and IgG4-related IPTs indicated that a combination of lymphocytes + plasma cells count, cytological atypia, IgG4 and ALK-1 staining will be helpful in differential diagnosis.

Pulmonary inflammatory pseudotumor with jaundice and anemia: A case report.

Pulmonary inflammatory pseudotumor with jaundice and anemia: A case report.

Diagnosis and treatment of autoimmune pancreatitis

Diagnosis and treatment of autoimmune pancreatitis

Response of Pulmonary Inflammatory Pseudotumor to Corticosteroid Therapy

Response of Pulmonary Inflammatory Pseudotumor to Corticosteroid Therapy

Pulmonary inflammatory pseudotumor due to Coxiella burnetii. Case report and literature review

A 58-year-old man was admitted because of respiratory failure, episodic fever with chilling, cough, malaise, fatigue, myalgia and weight loss lasting for at least one month. Chest x-rays and CT scan of the chest showed bilateral pulmonary consolidations in upper lobes, the left lower lobe, and mediastinal lymphadenopathy. Bronchoscopy with cytology was unremarkable. A needle CT-guided lung biopsy documented an inflammatory pseudotumor, lymphoplasmacytic type. Serology showed high titer antibodies to phase II Coxiella burnetii infection. Therapy with doxycycline and hydroxychloroquine for three months led to a complete resolution of symptoms and radiological findings, and a marked decrease in titers to Q fever.

肺癌との鑑別が困難であった肺炎症性偽腫瘍の1例

肺癌との鑑別が困難であった肺炎症性偽腫瘍の1例

Pulmonary inflammatory myofibroblastic tumor mimics lung cancer.

The term pulmonary inflammatory myofibroblastic tumor (IMT) has been adopted by the World Health Organization to refer to a variety of pulmonary diseases previously named inflammatory pseudotumor, plasma cell granuloma, fibroxanthoma, fibrous histiocytoma, pseudosarcomatous myofibroblastic tumor, and invasive fibrous tumor of the tracheobronchial tree.1Originally, IMT was regarded as a benign tumor, because its histological features included spindle cell proliferation, accompanied by prominent inflammatory cell infiltration.2Furthermore, this tumor had a response to non-steroidal anti-inflammatory agent treatment. However, evidence has suggested that IMT was a tumor of intermediate malignant potential, including adjacent tissue invasion, metastasis,3and genetic abnormalities.4Therefore, it is important to differentiate IMT from pulmonary inflammatory pseudotumor or sarcoma for the development of therapeutic protocol. To gain further knowledge about IMT, we will discuss two cases with unusual characteristics.

不典型肺Ca的X线误诊分析(附7例报告)

目的：通过7例不典型肺癌的X线征象分析与误诊教训，进一步提高不典型肺癌的X线诊断与鉴别诊断水平。方法：对我院2007~2012年间X线胸片首诊误诊的7例不典型肺Ca病例进行回顾性分析，逐例探讨其X线表现特征，综合分析寻找误诊原因。结果：误诊为肺炎或肺炎伴肺不张2例，肺炎性假瘤1例，肺结核2例，胸膜少量积液1例，纵隔旁淋巴结肿大1例。结论：不典型肺Ca的X线表现形式多种多样，必须综合分析，注重随访观察，方可减少误漏诊，提高不典型肺Ca诊断准确率。 Purpose: This article demonstrates how to develop the atypical lung cancer of X-ray diagnosis and identification diagnosis level by seven cases of atypical lung cancer of X-ray signs analysis and misdiagnosis lessons. Method: We conducted a retrospective analysis of the seven cases of atypical lung Ca which were first misdiagnosed between 2007 and 2012 in our hospital, investigated the performance characteristics of the X-ray case by case and analyzed the causes of misdiagnosis comprehensively. Results: 2 cases were misdiagnosed as pneumonia or pneumonia with atelectasis, 1 case of pulmonary inflammatory pseudotumor, 2 cases of pulmonary tuberculosis, 1 case of fewer pleural effusion and 1 case of lymphadenopathy next to mediastinal. Conclusion: Atypical lung Ca X-ray expresses in various forms, and we must analyze these forms comprehensively and focus on follow-up observation. Only in this way can we decrease the rate of misdiagnosis and improve the diagnostic accuracy of atypical lung Ca.

Pulmonary inflammatory myofibroblastic tumor and IgG4-related inflammatory pseudotumor: a diagnostic dilemma

IgG4-related inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) share morphological features like a prominent fibroblastic/myofibroblastic proliferation and the presence of inflammatory cells. Since IPT is managed conservatively and IMT is treated by surgical excision, it is important to differentiate these two lesions. The aim of this study is to highlight morphological and immunohistochemical features that distinguish IPT and IMT. Clinicopathological characteristics of cases diagnosed as pulmonary IPT or IMT from 1997 to 2013 were reviewed. The histological features were studied on hematoxylin and eosin-stained sections. Immunohistochemistry was done for IgG, IgG4, ALK-1, SMA, desmin, and CD34 for classification into IPT and IMT. Of the ten patients, seven were male and the age ranged from 4 to 58 years. The tumor size ranged from 1.5 to 4.0 cm in diameter. Histologically, proliferation of bland-looking spindle cells along with fibrosis and an inflammatory infiltrate comprising of lymphocytes and plasma cells were the common morphological features of both lesions. The spindle cell proliferation was more marked in IMT whereas lymphoplasmacytic infiltrate was more prominent in IPT. Obstructive phlebitis was observed only in cases of IPT. IgG4 expression was noted in IPT, and the number of IgG4-positive plasma cells and the ratio of IgG4+/IgG+ plasma cells were significantly lower in IMT than in IgG4-related IPT. Expression of anaplastic lymphoma kinase (ALK) was observed only in IMT, but not in IgG4-related IPT. The proportion of proliferating spindle cells, lymphoplasmacytic infiltrate, obstructive phlebitis, IgG4+ plasma cells and the ratio of IgG4+/IgG+ plasma cells, and ALK expression are helpful in differentiating these morphologically similar but biologically different lesions, which require different treatment modalities.

Case report of anti‐transcription intermediary factor‐1‐γ/α antibody‐positive dermatomyositis associated with gastric cancer and immunoglobulin G4‐positive pulmonary inflammatory pseudotumor

Dermatomyositis is a rare connective tissue disease often associated with internal malignancy and interstitial pneumonitis. Serologically, various auto-antibodies (Ab) are associated with dermatomyositis. Anti-transcription intermediary factor-1-γ/α (TIF-1-γ/α) Ab was recently identified as an auto-Ab and was observed mostly in cancer-associated dermatomyositis. IgG4-related disease is a newly described entity characterized by increased serum IgG4 levels and IgG4-positive plasma cell infiltration with fibrosis in organs such as the pancreas and parotid gland. IgG4-related disease also includes inflammatory pseudotumors in various organs. We report herein a 59-year-old Japanese man who had dermatomyositis complicated with a gastric cancer and an IgG4-related pulmonary inflammatory pseudotumor. He manifested typical classical Gottron's papules on the fingers, V-sign erythema on the chest, flagellate erythema on the back, nail fold bleeding and facial erythema. Serum levels of anti-TIF-1-γ/α Ab were positive as assessed by immunoprecipitation assay. He also had bilateral swelling of the parotid gland, and an excised specimen of the lung showed inflammatory pseudotumor with IgG4-positive plasma cells. As far as we know, this case is the first to report the association of IgG4-related disease and TIF-1-γ/α-positive dermatomyositis. Further accumulation of such cases is required to elucidate the mechanism of this association.

Dos formas de presentación del seudotumor inflamatorio pulmonar

Inflammatory pseudotumors are a relatively uncommon pathology of uncertain etiology, generally considered to be reactive in origin. They may be observed in different locations as single or multiple masses. One of the possible forms of presentation is intrapulmonary. Despite its low frequency, this pathology should be considered in the differential diagnosis of lung nodules, even though the histologic results and the imaging tests can become confusing. In addition, pulmonary inflammatory pseudotumors present a low malignancy with good response to surgical treatment as well as to pharmacological therapy, although to a lesser degree. We present a bibliographic review of this pathology based on two cases observed in our hospital. Both patients debuted with non-specific respiratory symptoms and lung nodules on imaging studies that were suspicious for neoplastic processes. After an exhaustive study, the diagnosis of pulmonary inflammatory pseudotumor was reached, with excellent responses to the treatment used in each case.

Pulmonary inflammatory pseudotumor observed by bronchoscopy and resected using video-assisted thoracic surgery

Pulmonary inflammatory pseudotumor is rare. A 34-year-old woman visited our hospital due to an abnormal chest shadow. Computed tomograhy showed a nodule in the right upper lobe. Bronchoscopy showed a polypoid endobronchial nodule obstructing most of the orifice of B2a. The nodule was white, glossy, and smooth, and it seemed to be covered with bronchial mucosa. However, transbronchial biopsy could not facilitate a diagnosis. To obtain a definitive diagnosis, we performed lobectomy of the right upper lobe using video-assisted thoracic surgery and removed the nodule completely. The pathologic diagnosis made during surgery was inflammatory pseudotumor. Immunohistochemical examination showed proliferating spindle cells were positive for vimentin and smooth muscle actin, but negative for epithelial markers. These findings were consistent with the staining pattern of inflammatory pseudotumor previously reported. Careful follow-up is necessary to detect any sign of local recurrence and distant metastases.

Two Types of Presentation of Pulmonary Inflammatory Pseudotumors

Inflammatory pseudotumors are a relatively uncommon pathology of uncertain etiology, generally considered to be reactive in origin. They may be observed in different locations as single or multiple masses. One of the possible forms of presentation is intrapulmonary.Despite its low frequency, this pathology should be considered in the differential diagnosis of lung nodules, even though the histologic results and the imaging tests can be confusing. In addition, pulmonary inflammatory pseudotumors present a low malignancy with good response to surgical treatment as well as to pharmacological therapy, although to a lesser degree.We present a bibliographic review of this pathology based on two cases observed in our hospital. Both patients debuted with non-specific respiratory symptoms and lung nodules on imaging studies that were suspicious for neoplastic processes. After an exhaustive study, the diagnosis of pulmonary inflammatory pseudotumor was reached, with excellent responses to the treatment used in each case.

A Case of Pulmonary Inflammatory Pseudotumor in a Child Showing a Coin Lesion

A Case of Pulmonary Inflammatory Pseudotumor in a Child Showing a Coin Lesion