Results of surgical treatment of patients with inflammatory pseudotumors of thoracic localization

Abstract

Introduction: Inflammatory pseudotumors (IPT) of thoracic localization are very rare neoplasms, that are poorly studied, difficult to diagnose and, having an uncertain potential for malignancy, can reach large sizes, recur and metastasize. Aim. To analyze the immediate and long-term results of surgical treatment in patients with IPT of thoracic localization. Methods. We retrospectively investigated data of patients with pulmonary lesions and the histopathologic diagnosis of IPT or its synonymous at the St. Petersburg Federal hospital №122 from 2010 to 2019. Every specimen has been investigated by immunostaining (IS). Results. There were 8 patients (5 female, 3 male) from 20 to 67 years. In 7 patients, the pathology was localized in the lungs, in 1 in the trachea. No cases were correctly verified preoperatively. Six anatomical lung resections, one wedge – all by VATS, and one circular tracheal resection were performed. All resections were R0. According to the IS, the diagnosis of an IPT was confirmed. In one case (tracheal pathology), immunoglobulin G4 (IgG4)-related IPT was detected (IS showed that a large part of the total plasma cells was IgG4-positive). In all cases, serum levels of IgG4 were normal. There were no postoperative complications, all patients were discharged within 7 days. A patient with IgG4-related IPT received a course of corticosteroid therapy, while others did not receive any drug therapy. The time of non-recurrent follow-up is from 9 to 60 months. Сonclusion. IPT of thoracic localization are rare, difficult to diagnose, and may be an IgG4-associated disease. Surgical resection of R0 is an effective and safe method of treatment.