A 28-year-old nonsmoking male was referred for diagnostic evaluation of recurrent mild haemoptysis associated with a right upper lobe solitary pulmonary nodule of 8 weeks duration. Chest radiograph revealed a 1.5 x 2 cm coin lesion in the posterior segment of the right upper lobe of the lung (Figure 1).
The medical history was noncontributory. A computed tomographic (CT) scan of the chest confirmed the chest radiograph findings; a solid mass was noted in the posterior segment of the right upper lobe of the lung with an area of central lucency (Figure 2).
There was no hilar lymphadenopathy. Sputum microscopy, culture, and cytological examination were noncontributory. The ESR was 14, the haemoglobin 14.6 g/dL, and the leukocyte count of 8.8 x 109/L. The other serum haematological and biochemical results were normal.
In view of the patient's ongoing haemoptysis and lack of response to antibiotics he was subjected to an exploratory thoracotomy and wedge resection of the lesion in the right upper lobe. A solid mass in the posterior segment of the right upper lobe was noted and it was excised. No associated lymphadenopathy was noted. Frozen section of the mass revealed no evidence of carcinoma or tuberculosis. The patient developed a right upper lobe lung abscess postoperatively, and underwent a complete right upper lobe lobectomy.
Macroscopically, a well-circumscribed tan-coloured nodule measuring 35 x 15 mm was present. The cut surfaces of the tumour revealed a haemorrhagic necrotic centre. Microscopically, the mass consisted of a heavy inflammatory cell infiltrate composed predominantly of lymphocytes, with plasma cells and histiocytes. Foamy histiocytes with macrophages were also seen, as well as occasional eosinophils and neutrophils. Focal areas of micro-abscess formation with necrosis were also noted. A marked degree of fibrosis of the interstitial tissue was present with proliferating myofibroblasts. The histological characteristics were compatible with an inflammatory myofibroblastic pseudotumour (organising pneumonia-like type; Figure 3).
The postoperative course was uneventful, the patient was discharged from the hospital one week later, and three years after surgical resection the patient remains well and free of disease.