Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2017; 5(2): 61-66
Published online Feb 16, 2017. doi: 10.12998/wjcc.v5.i2.61
Indolent lung opacity: Ten years follow-up of pulmonary inflammatory pseudo-tumor
Jad A Degheili, Nadim A Kanj, Salwa A Koubaissi, Mouhamad J Nasser
Jad A Degheili, Division of General Surgery, Department of Surgery, American University of Beirut-Medical Center, 1107 2020 Beirut, Lebanon
Nadim A Kanj, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, American University of Beirut-Medical Center, 1107 2020 Beirut, Lebanon
Salwa A Koubaissi, Department of Internal Medicine, American University of Beirut-Medical Center, 1107 2020 Beirut, Lebanon
Mouhamad J Nasser, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, American University of Beirut-Medical Center, 1107 2020 Beirut, Lebanon
Author contributions: Degheili JA and Nasser MJ have contributed equally to this work; both have been involved in the acquisition of patient’s data, literature review, and writing of initial draft; Koubaissi SA assisted in literature review and revision of the edited manuscript; Kanj NA is the senior author and has been involved in the revision of the different manuscript’s versions.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board at the American University of Beirut-Medical Center.
Informed consent statement: The patient highlighted in this case report gave his consensus prior to study enrollment, authorizing the use and disclosure of his protected health information.
Conflict-of-interest statement: All authors of this manuscript have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mouhamad J Nasser, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, American University of Beirut-Medical Center, Riad El-Solh, Hamra Street, P.O. Box 11-0236, 1107 2020 Beirut, Lebanon. mohammad-nasser@hotmail.com
Telephone: +961-3-050147
Received: March 27, 2016
Peer-review started: March 31, 2016
First decision: April 15, 2016
Revised: November 30, 2016
Accepted: December 13, 2016
Article in press: December 14, 2016
Published online: February 16, 2017
Abstract

Inflammatory pseudotumor (IPT) has always been considered a diagnostic challenge. Its rarity and resemblance to other more common pathological entities imposes that neither clinical nor radiological characteristics can lead to a definitive diagnosis. The surgical excision of the lesion is the ultimate approach for accurate diagnosis and cure. Moreover the true nature of IPT, its origin as a neoplastic entity or an over-reactive inflammatory reaction to an unknown trigger, has been a long debated matter. Surgery remains the treatment of choice. IPT is mostly an indolent disease with minimal morbidity and mortality. Local invasion and metastasis predict a poor prognosis. We hereby present a unique case of pulmonary IPT that was surgically excised, but recurred contralaterally, shortly thereafter. Despite no medical or surgical treatment for ten years, the lesion has remained stable in size, with neither symptoms nor extra-pulmonary manifestations.

Keywords: Inflammatory pseudotumor, Anaplastic lymphoma kinase, Inflammatory myofibroblastic tumor, Plasma cells granuloma, IgG4-related sclerosing disease

Core tip: Inflammatory pseudotumor is considered a diagnostic challenge, with no one-self explained pathophysiology. Over-reactive inflammatory response to various triggering agents or even an entity with malignant potentials represents the two-sided pendulum. Accurate pathological identification lies on adequate tissue acquisition, which often occurs during surgical resection; the preferred treatment approach. Even though both local recurrence and metastasis represent a poor prognosis, its indolent course is not a well-known property, which we do here highlight in our patient with a 10-year follow up, possessing a stable and indolent disease.