Hijikata Yoichiro, Nobashi Tomomi W, Sakamoto Ryo, Ikezoe Kohei, Handa Tomohiro, Menju Toshi, Otsuki Shinya, Katsuragawa Hiroyuki, Tsuji Kentaro, Nakamoto Yuji
Department of Diagnostic Radiology, Kyoto University Hospital, Kyoto, Japan.
Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan.
Radiol Case Rep. 2025 Sep 2;20(11):5774-5779. doi: 10.1016/j.radcr.2025.08.022. eCollection 2025 Nov.
A 52-year-old man was referred to our hospital for further evaluation after suspicious pulmonary shadows were detected on a routine health checkup. Chest CT revealed multiple nodular and mass-like lesions with mixed characteristics in both lungs, along with interlobular septal thickening and lymphadenopathy. FDG-PET demonstrated variable degrees of uptake across the lesions. A surgical biopsy of a mass in the left lower lobe yielded a pathological diagnosis of pulmonary hyalinizing granuloma (PHG). PHG is an extremely rare benign pulmonary condition of unknown etiology, that can be associated with various diseases. Histologically, the nodules are characterized by dense, eosinophilic hyalinized collagen arranged in concentric lamellae, frequently exhibiting a whorled or layered pattern. Radiologic findings typically include multiple bilateral pulmonary lesions; however, cavitation and calcification are rarely observed and are considered non-specific. Definitive diagnosis requires histological confirmation. In this case, no underlying or associated systemic diseases were identified histologically; however, the presence of interlobular septal thickening was atypical for previously reported PHG findings, raising the suspicion of a coexisting disease with lymphatic involvement. Close clinical and radiological follow-up is warranted to monitor for potential comorbid conditions.
一名52岁男性在常规健康检查中发现可疑肺部阴影后被转诊至我院作进一步评估。胸部CT显示双肺有多个具有混合特征的结节状和肿块样病变，伴有小叶间隔增厚和淋巴结病。FDG-PET显示病变有不同程度的摄取。对左肺下叶一个肿块进行手术活检，病理诊断为肺透明变性肉芽肿（PHG）。PHG是一种病因不明的极其罕见的良性肺部疾病，可与多种疾病相关。组织学上，结节的特征是致密的嗜酸性透明变性胶原呈同心层状排列，常呈漩涡状或分层状。影像学表现通常包括双侧肺部多发病变；然而，空洞形成和钙化很少见，且被认为是非特异性的。明确诊断需要组织学证实。在本例中，组织学上未发现潜在的或相关的全身性疾病；然而，小叶间隔增厚的表现与既往报道的PHG表现不同，这增加了存在伴有淋巴受累的共存疾病的怀疑。有必要进行密切的临床和影像学随访，以监测潜在的合并症。
