Localized pulmonary Wegener's granuloma simulating lung cancer: report of four cases

Clinical features suggesting lung disease in three patients and a chance chest radiograph in the fourth led to films showing localized lung lesions with some characteristics of neoplasms. Two were heavy smokers, two were non-smokers. In two the lesion was peripheral, in one lobar (RUL), and in the fourth it crossed the interlobar fissure (apical and posterior segments LUL and apical LLL). Malignant cells were not seen on sputum cytology examination in any, but in one, atypical cells were reported. All four patients had lung resection for suspected cancer, two by pneumonectomy, one by lobectomy, and one lingulectomy. All patients recovered, and their clinical course has so far been uniformly benign. Two have been followed long term (16 and 10 years), one 2 1/2 years, and one a year. Pathologically, the lesions appeared to be strictly limited without extra-pulmonary involvement, except that the patient followed for one year has developed hyporegenerative anaemia responsive to prednisone therapy. The pathological features of focal necrosis, granulomatous inflammation, and vasculitis were sufficiently striking, although often focal, to suggest that incisional biopsy from frozen-section histological diagnosis could be useful to prevent extensive lung resection for lesions not positively diagnosed before thoracotomy.