Khalid Imran, Stone Chad, Kvale Paul
*Division of Pulmonary and Critical Care †Department of Pathology, Henry Ford Health, System, Detroit, MI.
J Bronchology Interv Pulmonol. 2009 Apr;16(2):108-11. doi: 10.1097/LBR.0b013e31819b51db.
An 83-year-old obese woman with a 60-pack-year smoking history was referred for evaluation of an abnormal chest radiograph [chest x-ray (CXR)]. Her past medical history was significant for recurrent deep venous thrombosis without any predisposing factors. CXR showed a large mass in the right mid lung and another nodule at the right apex, highly suspicious for a neoplastic process. These were not present on a CXR from 2 years earlier. An fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scan revealed that all lesions were strongly FDG-avid. Six CT-guided core-needle lung biopsy specimens were obtained from the lung mass and all contained dense, lamellar, or "ropy" keloid-like collagen bundles arranged in a haphazard pattern. The biopsy specimens lacked significant necrosis and granulomas. Congo red stain with polarization was also negative for amyloid. The diagnosis of pulmonary hyalinizing granuloma (PHG) was made. A complete hypercoagulable workup was performed but no underlying abnormalities were found, including a negative lupus anticoagulant and malignancy workup. The patient was maintained on warfarin and followed with serial CT scans for 1 year, with spontaneous regression in the lung mass. The case is unique as it is the first case that reports an association of PHG with recurrent deep venous thrombosis in the absence of autoimmune or procoagulant factors and emphasizes the need for life-long anticoagulation in such scenarios. Also, we report the FDG-avid PET scan findings here that are novel for this disease in adults and add PHG to the list of diseases causing false-positive PET scans when malignancy is suspected.
一名83岁的肥胖女性，有60年的吸烟史，因胸部X光片（CXR）异常前来评估。她的既往病史中，复发性深静脉血栓形成较为显著，且无任何诱发因素。胸部X光片显示右肺中叶有一个大肿块，右肺尖还有一个小结节，高度怀疑为肿瘤性病变。而两年前的胸部X光片中并未出现这些病变。氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）显示，所有病变均表现为强烈的FDG摄取。从肺部肿块获取了6份CT引导下的芯针肺活检标本，所有标本均含有致密的、层状的或“索状”的瘢痕疙瘩样胶原束，排列杂乱无章。活检标本缺乏明显的坏死和肉芽肿。刚果红染色偏振光检查淀粉样蛋白也呈阴性。最终诊断为肺透明变性肉芽肿（PHG）。进行了全面的高凝状态检查，但未发现潜在异常，包括狼疮抗凝物阴性和恶性肿瘤检查阴性。患者持续服用华法林，并连续进行CT扫描随访1年，肺部肿块自发消退。该病例较为独特，因为这是首例报道在无自身免疫或促凝因素的情况下，PHG与复发性深静脉血栓形成相关的病例，并强调了在这种情况下进行终身抗凝的必要性。此外，我们在此报告了FDG摄取阳性的PET扫描结果，这在成人该疾病中是新发现，并且当怀疑有恶性肿瘤时，将PHG添加到可导致PET扫描假阳性的疾病列表中。
