Pulmonary necrotizing granulomas of unknown cause clinical and pathologic analysis of 131 patients with completely resected nodules

Sanjay Mukhopadhyay, Bradley E. Wilcox, Jeffrey L. Myers, Sandra C. Bryant, Seanne P. Buckwalter, Nancy L. Wengenack, Eunhee S. Yi, Gregory L. Aughenbaugh, Ulrich Specks, Marie Christine Aubry

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: The cause of pulmonary necrotizing granulomas is often unclear, even after histologic examination. Our aim was to determine the clinical signifi cance of histologically unexplained necrotizing granulomas. Methods: Pulmonary necrotizing granulomas surgically resected at the Mayo Clinic (1994-2004) were retrieved and reviewed retrospectively. Cases in which a cause was evident at the time of initial histologic examination were excluded. The analysis cohort comprised 131 completely resected histologically unexplained pulmonary necrotizing granulomas. Clinical and laboratory information was abstracted from medical records, chest CT scans were reviewed, histologic slides were reexamined, and additional ancillary studies were performed in selected cases. Results: A cause was determined on review in more than one-half of the histologically unexplained necrotizing granulomas (79 of 131, 60%) by reexamining histologic slides (47), incorporating the results of cultures (26), fungal serologies (14), and other laboratory studies (eight), and correlating histologic fi ndings with clinical and radiologic information (13). Infections accounted for the majority (64 of 79), the most common being histoplasmosis (37) and nontuberculous mycobacterial infections (18). Noninfectious diagnoses (15 of 79) were rheumatoid nodule (fi ve), granulomatosis with polyangiitis (Wegener) (fi ve), sarcoidosis (four), and chronic granulomatous disease (one). Many cases remained unexplained even after extensive review (52 of 131, 40%). Most of these patients received no medical therapy and did not progress clinically or develop new nodules (median follow-up, 84 months). Conclusions: A cause, the most common being infection, can be established in many surgically resected pulmonary necrotizing granulomas that appear unexplained at the time of initial histologic diagnosis. Patients whose granulomas remain unexplained after a rigorous review have a favorable outcome. Most do not develop new nodules or progress clinically, even without medical therapy.

Original languageEnglish (US)
Pages (from-to)813-824
Number of pages12
JournalChest
Volume144
Issue number3
DOIs
StatePublished - Sep 2013

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Granuloma
Lung
Infection
Rheumatoid Nodule
Chronic Granulomatous Disease
Histoplasmosis
Granulomatosis with Polyangiitis
Serology
Sarcoidosis
Medical Records
Cohort Studies
Thorax
Therapeutics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Mukhopadhyay, S., Wilcox, B. E., Myers, J. L., Bryant, S. C., Buckwalter, S. P., Wengenack, N. L., ... Aubry, M. C. (2013). Pulmonary necrotizing granulomas of unknown cause clinical and pathologic analysis of 131 patients with completely resected nodules. Chest, 144(3), 813-824. https://doi.org/10.1378/chest.12-2113

Pulmonary necrotizing granulomas of unknown cause clinical and pathologic analysis of 131 patients with completely resected nodules. / Mukhopadhyay, Sanjay; Wilcox, Bradley E.; Myers, Jeffrey L.; Bryant, Sandra C.; Buckwalter, Seanne P.; Wengenack, Nancy L.; Yi, Eunhee S.; Aughenbaugh, Gregory L.; Specks, Ulrich; Aubry, Marie Christine.

In: Chest, Vol. 144, No. 3, 09.2013, p. 813-824.

Research output: Contribution to journalArticle

Mukhopadhyay, S, Wilcox, BE, Myers, JL, Bryant, SC, Buckwalter, SP, Wengenack, NL, Yi, ES, Aughenbaugh, GL, Specks, U & Aubry, MC 2013, 'Pulmonary necrotizing granulomas of unknown cause clinical and pathologic analysis of 131 patients with completely resected nodules', Chest, vol. 144, no. 3, pp. 813-824. https://doi.org/10.1378/chest.12-2113
Mukhopadhyay, Sanjay ; Wilcox, Bradley E. ; Myers, Jeffrey L. ; Bryant, Sandra C. ; Buckwalter, Seanne P. ; Wengenack, Nancy L. ; Yi, Eunhee S. ; Aughenbaugh, Gregory L. ; Specks, Ulrich ; Aubry, Marie Christine. / Pulmonary necrotizing granulomas of unknown cause clinical and pathologic analysis of 131 patients with completely resected nodules. In: Chest. 2013 ; Vol. 144, No. 3. pp. 813-824.
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abstract = "Background: The cause of pulmonary necrotizing granulomas is often unclear, even after histologic examination. Our aim was to determine the clinical signifi cance of histologically unexplained necrotizing granulomas. Methods: Pulmonary necrotizing granulomas surgically resected at the Mayo Clinic (1994-2004) were retrieved and reviewed retrospectively. Cases in which a cause was evident at the time of initial histologic examination were excluded. The analysis cohort comprised 131 completely resected histologically unexplained pulmonary necrotizing granulomas. Clinical and laboratory information was abstracted from medical records, chest CT scans were reviewed, histologic slides were reexamined, and additional ancillary studies were performed in selected cases. Results: A cause was determined on review in more than one-half of the histologically unexplained necrotizing granulomas (79 of 131, 60{\%}) by reexamining histologic slides (47), incorporating the results of cultures (26), fungal serologies (14), and other laboratory studies (eight), and correlating histologic fi ndings with clinical and radiologic information (13). Infections accounted for the majority (64 of 79), the most common being histoplasmosis (37) and nontuberculous mycobacterial infections (18). Noninfectious diagnoses (15 of 79) were rheumatoid nodule (fi ve), granulomatosis with polyangiitis (Wegener) (fi ve), sarcoidosis (four), and chronic granulomatous disease (one). Many cases remained unexplained even after extensive review (52 of 131, 40{\%}). Most of these patients received no medical therapy and did not progress clinically or develop new nodules (median follow-up, 84 months). Conclusions: A cause, the most common being infection, can be established in many surgically resected pulmonary necrotizing granulomas that appear unexplained at the time of initial histologic diagnosis. Patients whose granulomas remain unexplained after a rigorous review have a favorable outcome. Most do not develop new nodules or progress clinically, even without medical therapy.",
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AU - Buckwalter, Seanne P.

AU - Wengenack, Nancy L.

AU - Yi, Eunhee S.

AU - Aughenbaugh, Gregory L.

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AB - Background: The cause of pulmonary necrotizing granulomas is often unclear, even after histologic examination. Our aim was to determine the clinical signifi cance of histologically unexplained necrotizing granulomas. Methods: Pulmonary necrotizing granulomas surgically resected at the Mayo Clinic (1994-2004) were retrieved and reviewed retrospectively. Cases in which a cause was evident at the time of initial histologic examination were excluded. The analysis cohort comprised 131 completely resected histologically unexplained pulmonary necrotizing granulomas. Clinical and laboratory information was abstracted from medical records, chest CT scans were reviewed, histologic slides were reexamined, and additional ancillary studies were performed in selected cases. Results: A cause was determined on review in more than one-half of the histologically unexplained necrotizing granulomas (79 of 131, 60%) by reexamining histologic slides (47), incorporating the results of cultures (26), fungal serologies (14), and other laboratory studies (eight), and correlating histologic fi ndings with clinical and radiologic information (13). Infections accounted for the majority (64 of 79), the most common being histoplasmosis (37) and nontuberculous mycobacterial infections (18). Noninfectious diagnoses (15 of 79) were rheumatoid nodule (fi ve), granulomatosis with polyangiitis (Wegener) (fi ve), sarcoidosis (four), and chronic granulomatous disease (one). Many cases remained unexplained even after extensive review (52 of 131, 40%). Most of these patients received no medical therapy and did not progress clinically or develop new nodules (median follow-up, 84 months). Conclusions: A cause, the most common being infection, can be established in many surgically resected pulmonary necrotizing granulomas that appear unexplained at the time of initial histologic diagnosis. Patients whose granulomas remain unexplained after a rigorous review have a favorable outcome. Most do not develop new nodules or progress clinically, even without medical therapy.

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