Treatment of plasma cell granuloma of the lung with radiation therapy. A report of two cases and a review of the literature.

Plasma cell granuloma is a rare, benign tumor that affects people at all ages and most frequently involves the lung, gastrointestinal tract, and salivary gland. They are the most common, isolated, primary lesion of the lung in children less than 16 years of age, and usually present as circumscribed, peripheral, parenchymal tumors, which may be static or increase slowly in size without causing symptoms. Whereas surgical excision is the treatment of choice, there are situations in which the lesion cannot be resected without significant morbidity because of direct extension into the mediastinum or lymph nodes. In these circumstances, radiation therapy may be a better therapeutic option. Two cases of plasma cell granuloma that could not be completely resected are described. The patients were treated with radiation therapy consisting of 4320 rad in 4.5 weeks and 4500 rads in 4.5 weeks, respectively, and both have been cured. Although surgery as the primary treatment for most patients is still recommended, especially in the young so the potential side effects of radiation therapy can be avoided, the authors believe that in rare cases where the lesion is locally aggressive and surgically unresectable or resectable only with major morbidity, radiation therapy can be an effective alternative. Currently, the recommended treatment is 4000 to 4500 rad given in 180 to 200 rad fractions, with the fields being carefully tailored to tumor volume in order to minimize the dose to the surrounding normal tissue.