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Case Reports in Pulmonology
Volume 2012, Article ID 102196, 5 pages
http://dx.doi.org/10.1155/2012/102196
Case Report

Diagnostic and Therapeutic Challenges of a Large Pleural Inflammatory Myofibroblastic Tumor

1Pneumology/USPH Innsbruck, Department of Internal Medicine VI, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
2Clinic of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
3Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
4Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria
5Department of Nuclear Medicine, Innsbruck Medical University, Innsbruck, Austria
6Institute of Pathology, Innsbruck Medical University, Innsbruck, Austria

Received 30 September 2012; Accepted 16 December 2012

Academic Editors: M. Berman, U. Gonlugur, G. Hillerdal, C. Weiler, and H. Wilkens

Copyright © 2012 Judith Loeffler-Ragg et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a 48-year-old woman with a pleural pseudoneoplasm requiring different diagnostic and therapeutic strategies. After initial presentation with increasing dyspnoea, temperature, dry cough, and interscapular pain diagnostic processing showed a large mediastinal mass with marked pleural effusion and high metabolic activity in the 18F-FDG-PET/CT. Extensive CT-guided biopsy of the tumor reaching from the visceral pleura into the right upper lobe revealed no malignancy, but a marked inflammatory tissue reaction containing foam cells. Initial empiric antibiotic therapy was temporarily successful. However, in the further course the mass relapsed and was resistant to antibiotics and a corticosteroid trial. With the working hypothesis of an inflammatory myofibroblastic tumor the patient underwent surgical tumor resection, finally confirming the suspected diagnosis. Due to residual disease intravenous immunoglobulins were administered leading to sustained response. This case with a pleural localisation of a large inflammatory pseudotumor with responsiveness to immunomodulation after incomplete resection extends the reported spectrum of thoracopulmonary manifestations of this rare entity.