J Korean Med Sci.  2006 Dec;21(6):1117-1120. 10.3346/jkms.2006.21.6.1117.

Plasma Cell Granuloma Associated with Pulmonary Actinomycosis: A Case Report

• Park SJ
• Lee YC
• Rhee YK
• Kweon EY
• Lee HB

• KMID: 1713131
• DOI: http://doi.org/10.3346/jkms.2006.21.6.1117

Abstract

Plasma cell granuloma (PCG) of the lung is a rare disease that usually presents as a pulmonary nodule or mass on incidental radiographic examination without symptoms. Although the etiology of PCG is still controversial, many findings have lent support to the lesion being a reactive inflammatory process rather than a neoplastic one. We describe a 53-yr-old male who presented with a hemoptysis and have a lung mass at the left upper lobe on chest radiograph. The lung mass was primarily diagnosed as PCG by percutaneous needle aspiration and biopsy, and the patient was treated with oral steroid because he and relatives refused the operation. However, the size of the lung mass did not change and open thoracotomy and lobectomy were done therefore. He was confirmed as having pulmonary actinomycosis with PCG after surgery. To our knowledge, this is the first report of PCG associated with actinomycosis in Korea.

Keyword

Actinomycosis; Granuloma, Plasma Cell

MeSH Terms

Middle Aged
Male
Lung Diseases/*complications/*diagnosis
Humans
Granuloma, Plasma Cell/*complications/*diagnosis
Actinomycosis/*complications/*diagnosis

Figure

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  Fig. 1 Chest PA (A) and chest CT (B) at admission demonstrate a well demarcated 3×2 cm-sized heterogeneous mass with central cavity and peripheral spiculation in the left upper lobe. Chest PA (C) and chest CT (D) after one-month steroid treatment show a similar or mildly increased size of the mass.

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  Fig. 2 The tissue obtained by percutaneous transthoracic needle biopsy shows spindle cells (A) and plasma cells (B) (hematoxylin and eosin stain, ×400).

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  Fig. 3 (A) The 2×2.5 cm-sized mass in the resected left upper lobe is composed of central solid components with surrounding necrotic and fibrotic tissues. (B) notes the sulfur granule (arrowheads) in the cavity lined with squamous epithelium (hematoxylin and eosin stain, ×100). (C) Gomori methenamine silver staining shows a lot of dark-stained and rod-shaped Actinomyces (×400). (D) shows the peripheries of the specimens obtained by needle biopsy and lobectomy, respectively. The microscopic finding consists of spindle-shaped cells and inflammatory cells (hematoxylin and eosin stain, ×200).

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