SHM Converge Scientific Abstract ePoster Gallery-Multifocal Inflammatory Pseudotumor: A Challenging Diagnosis

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A 40-year-old woman with a possible history of rheumatoid arthritis presented with months of worsening fatigue, pleuritic chest pain, intermittent hemoptysis, and anemia. Imaging revealed multifocal FDG-avid hypermetabolic lesions involving both lungs, soft tissue near the spleen and stomach, the right temporal bone, and the ascending colon, raising concern for malignancy. Initial CT-guided lung biopsy and pleural fluid studies were nondiagnostic and showed only inflammation. Laboratory evaluation demonstrated elevated ESR and CRP, a positive ANA, and otherwise negative autoimmune and infectious workup.<br /><br />Because the lesions were diffuse and the diagnosis remained unclear, she underwent VATS biopsy of the largest lung mass. Histopathology showed an inflammatory pseudotumor with myofibroblastic proliferation on a background of lymphoplasmacytic inflammation. Testing was negative for carcinoma, lymphoma, EBV, HHV8, IgG4-related disease, ALK rearrangement, and sarcoma-associated gene fusions.<br /><br />Given the multifocal, unresectable nature of disease, the patient was started on a high-dose steroid taper.<br /><br />This case highlights how inflammatory pseudotumor can closely mimic metastatic cancer on clinical and radiographic grounds, making diagnosis difficult. IPTs are rare benign, non-metastatic lesions that may be associated with infection, autoimmune disease, trauma, or reactive inflammatory processes. While surgical excision is standard for solitary lesions, multifocal disease often requires medical therapy such as corticosteroids or other antineoplastic agents.

Asset Subtitle

Janet O. Adeola

Meta Tag

Author List Jacob Feldman, Jacqueline Pujol, Janet O. Adeola, Michael Nichols

Category Clinical Vignettes

Concept Inflammatory Pseudotumor

Concept Malignant Mimicker

Concept Diagnostic Workup

Concept Biopsy

Concept Histopathology

Distinguished Non-Finalist

Presenter Organization MedStar Georgetown University Hospital

Presenting Author Janet O. Adeola

Track Adult

Keywords

inflammatory pseudotumor

multifocal lung lesions

FDG-avid hypermetabolic lesions

pleuritic chest pain

hemoptysis

anemia

myofibroblastic proliferation

lymphoplasmacytic inflammation

corticosteroid therapy

rheumatoid arthritis

Inflammatory Pseudotumor

Malignant Mimicker

Diagnostic Workup

Biopsy

Histopathology