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Brotherly Love: A Case of Pulmonary Plasma Cell Granuloma in Twin Brothers
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A4068 - Brotherly Love: A Case of Pulmonary Plasma Cell Granuloma in Twin Brothers
Author Block: J. Sadik, R. Restrepo-Jaramillo; Pulmonary Disease/Critical Care Medicine, University of South Florida, Tampa, FL, United States.
INTRODUCTION- Plasma cell granulomas are a very rare benign lesion of the lung and gastrointestinal tract that occur due to myofibroblastic inflammation in these organ systems. In literature, these lesions have shown no familial relationship and have been presumed to occur in reaction to viral or bacterial infection. We present a case of twin brothers who were diagnosed with biopsy-proven plasma cell granulomas of the lung.
DESCRIPTION- Our patient is a 39-year-old male who was in otherwise good health when he was diagnosed with plasma cell granuloma of the right upper lobe (RUL) in 1996 after a surgical wedge resection of a pulmonary nodule found incidentally on a chest x ray. On serial follow up with annual CT chest studies, he was found to have a local recurrence of the plasma cell granuloma in the RUL. He subsequently underwent a right pneumonectomy due to concerns for possible future invasive transformation. In 2008, he was found to have a new left upper lobe lesion that was presumed to be another plasma cell granuloma, however due to concern for maintaining viability of his remaining lung, no surgical investigation for confirmation or removal was pursued. This lesion had remained stable and eventually decreased in size on subsequent CT chest imaging with corticosteroid therapy (based on anecdotal evidence of steroid responsiveness of these lesions). In early 2017, the patient’s twin brother presented to his primary physician with complaints of unrelenting sporadic cough which led to a CT chest study. He was found to have a large 4cm left lung lesion that was concerning for malignancy. He underwent wedge resection of the lesion. On frozen section examination, the lesion was confirmed to be plasma cell granuloma.
DISCUSSION- Plasma cell granulomas are a rare pulmonary lesion that are typically benign and seldom recur. Based on immunohistochemical evaluations in the past, reactive inflammation has been generally accepted as the likely cause. The presence of biopsy-proven plasma cell granuloma in the case of our patient and his twin brother indicate there may be a genetic predisposition or possible inheritance pattern responsible. This warrants further investigation into the possible genetic association of these lesions.
Author Block: J. Sadik, R. Restrepo-Jaramillo; Pulmonary Disease/Critical Care Medicine, University of South Florida, Tampa, FL, United States.
INTRODUCTION- Plasma cell granulomas are a very rare benign lesion of the lung and gastrointestinal tract that occur due to myofibroblastic inflammation in these organ systems. In literature, these lesions have shown no familial relationship and have been presumed to occur in reaction to viral or bacterial infection. We present a case of twin brothers who were diagnosed with biopsy-proven plasma cell granulomas of the lung.
DESCRIPTION- Our patient is a 39-year-old male who was in otherwise good health when he was diagnosed with plasma cell granuloma of the right upper lobe (RUL) in 1996 after a surgical wedge resection of a pulmonary nodule found incidentally on a chest x ray. On serial follow up with annual CT chest studies, he was found to have a local recurrence of the plasma cell granuloma in the RUL. He subsequently underwent a right pneumonectomy due to concerns for possible future invasive transformation. In 2008, he was found to have a new left upper lobe lesion that was presumed to be another plasma cell granuloma, however due to concern for maintaining viability of his remaining lung, no surgical investigation for confirmation or removal was pursued. This lesion had remained stable and eventually decreased in size on subsequent CT chest imaging with corticosteroid therapy (based on anecdotal evidence of steroid responsiveness of these lesions). In early 2017, the patient’s twin brother presented to his primary physician with complaints of unrelenting sporadic cough which led to a CT chest study. He was found to have a large 4cm left lung lesion that was concerning for malignancy. He underwent wedge resection of the lesion. On frozen section examination, the lesion was confirmed to be plasma cell granuloma.
DISCUSSION- Plasma cell granulomas are a rare pulmonary lesion that are typically benign and seldom recur. Based on immunohistochemical evaluations in the past, reactive inflammation has been generally accepted as the likely cause. The presence of biopsy-proven plasma cell granuloma in the case of our patient and his twin brother indicate there may be a genetic predisposition or possible inheritance pattern responsible. This warrants further investigation into the possible genetic association of these lesions.
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