Pulmonary inflammatory pseudotumor
Updates to Article Attributes
Pulmonary inflammatory pseudotumours (PIP's) are solid, non-neoplastic masses which can mimic pulmonary malignancy. They should not be confused with pulmonary pseudotumours which usually refer to loculated collections of pleural fluid mimicking a pulmonary mass on chest radiography.
Pathology
Thought to occur from an uncontrolled response to lung tissue injury. Lesions are typically solitary with a lower lobe predilection.
Pathologically, pulmonary inflammatory pseudotumours are typically well-defined, firm, lobulated parenchymal nodules or masses with a whorled and often heterogeneous appearance on cross-section.
Histologically, there is proliferation of spindle-shaped fibroblasts and permeation of collagen with lymphocytes, fibrosis, granulomatous inflammation, lymphoid hyperplasia, and intra-alveolar fibrosis at the edge of the lesion.
Radiographic features
Plain radiograph
Features on chest radiographs can vary but frequently mimics a solitary, well circumscribed, peripheral lung mass with calcifications in situ. May have an anatomical bias for the lower lobes.
CT
CT most commonly shows a well-marginated, lobulated mass of heterogeneous attenuation with variable patterns of contrast enhancement and calcification. Cavitation and lymphadenopathy are rare.
Treatment and prognosis
- some authors advocate resection 4
Differential diagnosis
The differential can be quite wide, specific considerations include
- solitary metastases from an osteosarcoma or mucinous tumour
- intra-thoracic soft tissue sarcoma
- pulmonary hamartoma
-<li>solitary metastases from an <a title="Osteosarcoma" href="/articles/osteosarcoma">osteosarcoma</a> or mucinous tumour</li>- +<li>solitary metastases from an <a href="/articles/osteosarcoma">osteosarcoma</a> or mucinous tumour</li>