Original article
General thoracic
Localized Organizing Pneumonia: Report of 21 Cases

https://doi.org/10.1016/j.athoracsur.2007.01.062Get rights and content

Background

Thoracic surgeons have limited experience with treating localized organizing pneumonia owing to its rare occurrence in routine clinical practice.

Methods

We retrospectively investigated the clinicopathologic features of 21 patients with localized organizing pneumonia observed between 2001 and 2004.

Results

There were 15 men and 6 women. Mean age was 63 years. Eight patients (38%) were symptomatic. Computed tomographic scan showed a single lesion in 17 patients (12 nodules and 5 masses) and bilateral lesions in 4. Wedge resection was performed in 16 patients and lobectomy in 5. There was no operative mortality. Follow-up was complete in all patients (range, 2 to 46 months; median, 20 months). Surgery was curative in 15 of 17 patients with a single lesion, and no recurrence was observed (p < 0.005). The remaining 2 patients with a single lesion (2 masses) had a local relapse with the appearance of nodular lesions in the residual parenchyma. Both these patients received steroids with resolution of the lesions. All 4 patients with bilateral lesions who underwent surgery for diagnostic purposes received steroids with improvement of the radiologic aspect in 3 and stabilization of the lesions in 1.

Conclusions

Clinical and radiologic findings of localized organizing pneumonia are nonspecific, and this unusual entity is difficult to differentiate from a primary or metastatic tumor. Surgical resection allows both diagnosis and cure. However, considering the benignity of the lesion and the efficacy of steroids, major pulmonary resections should be avoided.

Section snippets

Patients and Methods

This was a retrospective study, and, as individual patients were not identified, our ethics committee waived the requirement to obtain patient consent in the study. We reviewed the pathologic registries of the San Raffaele Scientific Institute, Milan, and Carlo Poma Hospital, Mantua, covering a 3-year period (August 2001 through October 2004) to identify all the patients with localized pulmonary abnormalities (nodules or masses) that had been shown to consist of BOOP at pathologic examination.

Results

We identified 25 patients with pathologic and radiologic evidence of localized organizing pneumonia. Four patients were excluded from the study because localized organizing pneumonia was an incidental finding occurring in the immediate vicinity of other processes (tumors, bronchiectases, and pulmonary sequestration) for which the resection had been performed. The remaining 21 patients were included in the study. There were 15 men and 6 women with a mean age of 63 years (range, 46 to 81 years).

Comment

Although rare, localized organizing pneumonia is an extremely interesting entity for the thoracic surgeon, who may have to differentiate it from a primary or metastatic lung tumor. Described for the first time in 1989 by Cordier and colleagues [13], localized organizing pneumonia has subsequently been analyzed as a distinct form of BOOP in only a few studies [9, 10, 11, 14, 15]. Unlike typical BOOP, its clinical, radiologic, and evolutive characteristics are therefore not entirely clear.

References (21)

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