Eur J Cardiothorac Surg 2002;22:626
© 2002 Elsevier Science NL
Images in cardio-thoracic surgery |
Wegener disease mimicking central lung cancer
Alfredo Cesarioa*,
Elisa Meaccia,
Antonino Mulèb,
Stefano Margaritoraa
a Division of General Thoracic Surgery, Department of Surgical Sciences, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome, Italy
b Department of Pathology, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168 Rome, Italy
Received 8 February 2002;
accepted 16 June 2002.
* Corresponding author. Tel.: +39-335-836-6161; fax: +39-6-305-1162
e-mail: alfcesario{at}yahoo.com
Key Words: Wegener disease • Lung cancer
A 58 year-old female was referred to our Division for a right central pulmonary mass strongly suggestive of central lung cancer (Fig. 1)
.
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Fig. 1. Computed tomography scan of the thorax showing a right hilar dishomogeneous mass, infiltrating the right main bronchus.
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An endo-bronchial biopsy was undertaken. Histology showed a granulomatous lesion (Figs. 2A,B)
. Fine needle aspiration cytology (Figs. 2C,D) showed an epithelioid aggregate and giant multinucleated cells.
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Fig. 2. (A) granulomatous lesion made of epithelioid istiocytes with rich granulocytic infiltrate; (B) monocytes and granulocytes infiltrate surrounding the thickened wall of a small caliber vessel (arrow); (C) epithelioid istiocytes aggregate, eosinophilic granulocytes and scattered epithelial cells without atypias (arrow); and (D) multinucleated giant cells observed in cytology but not in bioptic specimen.
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The final diagnosis, supported by elevated serum perinuclear antineutrophilic cytoplasmic antibodies (p-ANCA) levels is consistent with Wegener disease.
