Non-Hodgkin Lymphoma Presenting With Pulmonary Hyalinizing Granuloma: A Rare Clinical Entity.

Pulmonary hyalinizing granuloma (PHG) is an unusual benign pulmonary disease with nonspecific symptoms and slow progression, characterized by solitary or multiple fibrosing nodules. A definitive diagnosis of PHG usually requires a wide excisional biopsy. Associations of PHG with lymphoproliferative disorders, such as Castleman's disease and lymphoma, have been described. PHG is considered a paraneoplastic manifestation of those diseases. Treatment in most cases comprises therapy of the underlying condition with or without the use of empirical corticosteroid therapy. We report a case of a 57-year-old Caucasian female, who presented initially with dyspnea, fatigue, dry mouth, difficulty swallowing, night sweats, weight loss, and recurrent sinusitis. A physical examination revealed hepatosplenomegaly with generalized lymphadenomegaly. Chest computed tomography showed bilateral diffuse nodular changes about 10 mm in diameter in the lung parenchyma. A needle biopsy of a lymph node confirmed the diagnosis of non-Hodgkin lymphoma and chemotherapy was started. Since the parenchymal lung lesions progressed and no definite diagnosis could be made on the basis of transbronchial biopsy, a right-sided video-assisted thoracoscopy with atypical resection of the abnormalities was performed. The findings were consistent with a diagnosis of pulmonary hyalinizing granuloma. Due to preserved pulmonary function, there was no indication for starting corticosteroid therapy. The purpose of this case report is to draw attention to the possibility of pulmonary hyalinizing granuloma as a differential diagnosis when multiple nodular lesions are observed in the lungs. Although PHG is a rare entity, due to its frequent association with underlying diseases and nonspecific presentation, a careful investigation should be performed. For a definite diagnosis, a surgical biopsy is required.

Mediastinal Cartilaginous Hamartoma.

Pulmonary hamartomas are usually solitary, nodular benign lesions in the parenchyma of the lung. They are rarely situated in endobronchial areas, and very few cases are reported with the mediastinum.  A 56-year-old female patient got a CT-scan conducted due to coughing and breathlessness and was diagnosed with a nodular lesion in the medial mediastinum. The lesion was operated: it measured up to 4 cm in the largest diameter, had a smooth surface, was of rather soft but elastic consistency, and was extirpated. At pathology, on cut section, it was yellowish and lobular, and with a mixture of cartilaginous, fibrous and adipose tissues with some smooth muscle cell fibers and myxoid areas. The diagnosis of pulmonary hamartoma was made with atypical medial mediastinal localization. This rare presentation could pose some differential diagnostic problems in the clinical diagnosis of more frequent primary and metastatic malignant diseases.

Solitary Fibrous Tumor of the Dorsal Tongue Area.

Solitary fibrous tumor (SFT) is a rare tumor occurring in pleura or extrapleural areas. The tongue is infrequently affected, in less than 25 published cases. A female patient, 35 years of age, noticed an oval mass in the posterior dorsal part of the tongue. The operated mass was nodule, 10 mm in size, sharply circumscribed, rather firm. The histology shows uniform CD34 positive spindle tumor cells. The diagnosis of benign SFT of the tongue was made.