Inflammatory pseudotumors of the lung

Background. Inflammatory pseudotumors of the lung are rare and often presen t a dilemma for the surgeon at time of operation. We reviewed our experienc e with patients who have this unusual pathology. Methods. Between February 1946 and September 1993, 56,400 general thoracic surgical procedures were performed at the Mayo Clinic. Twenty-three patient s (0.04%) had resection of an inflammatory pseudotumor of the lung. There w ere 12 women and 11 men. Median age was 47 years (range, 5 to 77 years). Si x patients (26%) were less than 18 years old. All pathologic specimens were rereviewed, and the diagnosis of inflammatory pseudotumor was confirmed. E ighteen patients (78%) were symptomatic which included cough in 12, weight loss in 4, fever in 4 and fatigue in 4. Four patients had prior incomplete resections performed elsewhere and underwent re-resection because of growth of residual pseudotumor. Wedge excision was performed in 7 patients, lobec tomy in 6, pneumonectomy in 6, chest wall resection in 2, segmentectomy in 1, and bilobectomy in 1. Complete resection was accomplished in 18 patients (78%). Median tumor size was 4.0 cm (range, 1 to 15 cm). There were no ope rative deaths. Follow-up was complete in all patients and ranged from 3 to 27 years (median, 9 years). Results. Overall 5-year survival was 91%. Nineteen patients are currently a live. Cause of death in the remaining 4 patients was unrelated to pseudotum or. The pseudotumor recurred in 3 of the 5 patients who had incomplete rese ction; 2 have had subsequent complete excision with no evidence of recurren ce 8 and 9 years later. Conclusions. We conclude that inflammatory pseudotumors of the lung are rar e. They often occur in children, can grow to a large size, and are often lo cally invasive, requiring significant pulmonary resection. Complete resecti on, when possible, is safe and leads to excellent survival. Pseudotumors, w hich recur, should be re-resected. (Ann Thorac Surg 1999;67:933-6) (C) 1999 by The Society of Thoracic Surgeons.