[Limited-form Wegener's granulomatosis without anti-neutrophil cytoplasmic antibody]

A 78-year-old woman was admitted because of dry cough and weight loss. A computed tomographic (CT) scan of the thorax showed multiple masses in both lungs with and without cavitation. No other organ lesions were detected. The patient was seronegative for antineutrophil cytoplasmic antibody (ANCA) and a routine sputum culture was normal. Because specimens from transbronchial and CT-guided transluminal lung biopsies disclosed non-specific granuloma with necrosis, an excisional biopsy of the mass by video-assisted thoracoscopic surgery was performed. The specimens contained geographic basophilic necrosis with palisading histiocytes, giant cells, and neutrophils. A limited form of Wegener's granulomatosis was diagnosed on the basis of the clinical and pathological features and effects of treatment.