Case Report
Metachronous Inflammatory Pseudotumor involving the Lung and the Brain: a case report
https://doi.org/10.21203/rs.3.rs-2447267/v1
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Inflammatory pseudotumors (IPT) is a rare neoplasm and frequently involved in the lung during childhood. IPT metachronous or synchronize involves lung and brain is quite rare. Only five cases were reported in English literature and all of them were male children and adolescents, here we reported the sixth case in the middle-aged woman. The definitive diagnosis of the lesions depends on histopathology, which radiological appearance is easily mimic lung cancer combined with brain metastasis.
Inflammatory pseudotumors
lung
brain
case report
Inflammatory pseudotumors (IPT), also known as inflammatory myofibroblastic tumors (IMT), cellular inflammatory pseudotumours and plasma cell granulomas, is a rare benign tumor of clearly unknown etiology[1]. IPT are most frequently seen in childhood. The most common involvement is seen in the lungs, but the lesion has been reported in almost every organ of the body, including intra-abdominal organs, gastrointestinal tract, mesentery, brain and so on. Inflammatory pseudotumor in brain is quite rare. A total of five IPT cases metachronously or synchronizely involved lung and brain[2–6],but of whom were children and adolescent males (Details in Table 1). We present here a case in whom the metachronous lesions involved in the lung and brain in the female adult. In terms of image manifestation, lung cancer with intracranial metastasis is more commonly considered in the clinical practice.
| Study | Age/Sex | Size of the lesion in the lung | Size of the lesion in the brain | Location of the lesion in the lung | Location of the lesion in the brain | metachronous or synchronize | Therapy |
|---|---|---|---|---|---|---|---|
| Tang et al | 13Y/M | 8cm | 1.5cm | Right middle lobe | Left parietooccipital region | Synchronize | Irradiation therapy was instituted both in the lung and brain before total excision of the tumor mass. It may be irradiation resistance. |
| Greiner et al | 13Y/M | NA | 1cm | Left inferior lobe | Right frontal lobe | Metachronous | Completely resection |
| Chan et al | 8Y/M | 3cm | NA | Right lower lobe, two more lesions were found in the right pneumonectomy space two years later. | Multiple intracranial lesions | Metachronous | A course of chemotherapy but no response. a right pneumonectomy with carinal resection and lesion recurred two years later, eventually, further surgery is withheld |
| LeMarc'Hadour et al | 28Y/M | 1-3cm | NA | Three well-delineated nodules of the right inferior lobe | One lesion located in the lateral aspect of the left cavernous sinus, petrous apex and tentorium cere belli two years later, the presence of an intracerebral process that was roughly the same size as two years previously. | Metachronous | Resected of the brain lesion in the first time, partial resected the brain lesion in the second time. Resection of the largest pulmonary nodule, the two others remaining in situ, two months after the last surgical intervention, the patient was well under steroid therapy. |
| Malhotra et al | 20Y/M | NA | NA | The upper lobe of right lung | Three lesions in the brain | Metachronous | Resect the lung lesion and one of the brain lesions. |
A 55-year woman was admitted to hospital with recurrent cough for 3 months and cough aggravation for 1 day, and without fever. Blood routine examination showed that the white blood cell count was 10.06×109/L, the neutrophil count was 8.44×109/L, the neutrophil percentage was 83.90%. Other biochemical indexes showed no relevant s abnormalities. Computed tomographic (CT) scan of the chest revealed a solid lesion in the right inferior lobe(size:2.9cm*3.9cm*3.2cm,), which was oval shapes and with irregular borders. The bronchus of the basal segment of the lower lobe of the right lung narrowed, and with pneumonia of the right lung. The lesion was slight enhancement on contrast scan. The imaging findings were initially interpreted as lung cancer. (Fig. 1.). The lesion was completely removed by anatomical resection of the right inferior lobe lung. The postoperative course was uneventful and histologically a IPT was diagnosed (Fig. 1.).
After two months, the patient was admitted again with sudden left leg weakness for 3 days. Head CT revealed hypodensity in the right frontal and parietal lobes, while head CT scan showed no abnormality two months ago. MRI showed nodular abnormal signals of about 1.2cm*1.3cm*1.5cm in size in the right parietal lobe, hypo-intensity on T1WI, iso-intensity on T2WI and Flair, slightly hypo-intensity on DWI, and with large patchy long T1 and long T2 cerebral edema around the lesion, and obvious enhancement of the lesion and meningeal enhancement in its adjacent on enhancement scan (Fig. 2.). Upon inspection, there was a space-occupying lesion in brain, which suggested a malignant lesion and a high likelihood of being a brain metastasis. The diagnosis of metastatic tumor must be secondary to primary tumor, but there is no evidence that the patient had a primary tumor, based on their medical history, physical examination, and tests for blood tumor markers. The results had confounded clinicians and radiologists. Even if this is the case, surgical resection remains the first choice of treatment. Postoperative pathological examination of the right parietal lobe showed chronic inflammation after intracranial tumor resection (Fig. 2.).
IPT metachronous or synchronize involved lung and brain is rare. The clinical symptoms and imaging findings were not specific. Although the definitive diagnosis of the lesions depends on histopathology, when the mass in the lung excludes the tumor and was pathologically diagnosed as IPT, synchronize or metachronous intracranial lesions in the brain should be taken into account the possibility of IPT.
Ethics approval and consent to participate: This case report was approved by our institutional ethics committee. Written informed consent was waived from the patient.
Consent for publication: Each Author agreed for publication.
Ethical Statement: Written Informed consent was obtained from the patient for publication of this case report.
Availability of data and materials: The datasets used during the current study available from the corresponding author on reasonable request.
Competing interests: Authors declare that there is no conflict of interests regarding the publication of this case report.
Funding: This case report did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions: Ze Bing Xu and Yan Deng rote the main manuscript text and prepared CT/MRI images, and Huang Wang prepared pathological pictures. All authors reviewed the manuscript.
Acknowledgements: We would like to express our gratitude to all those who have helped us during the writing of our thesis. We would like to thank the teachers in our Departments of Pathology and Radiology for their help.
No competing interests reported.
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