Bronchocentric Granulomatosis With Mucus Impaction Due to Bronchogenic Carcinoma

Abstract

Abstract Objective.—To describe an unexpected inflammatory process associated with malignancy in the lung and to postulate a new mode of pathogenesis. Design.—Retrospective review of surgical pathologic findings. Setting.—Academic hospital pathology department. Patients.—Four patients, 2 men and 2 women, ranging in age from 45 to 74 years, each of whom had a solitary mass on chest radiographs. Interventions.—Pulmonary lobectomy. Main Outcome Measure.—Histopathologic identification of bronchocentric granulomatosis. Results.—Accompanying a bronchogenic carcinoma in each case was a necrotizing chronic granulomatous reaction centered around bronchioles that were plugged with mucus, necrotic detritus from the tumor, lipid, or a combination of these substances. Eosinophils were present in small numbers in one case. The pathologic findings characterize bronchocentric granulomatosis. Conclusions.—The presence of bronchocentric granulomatosis in the biopsy of a mass does not exclude the presence of an accompanying bronchogenic carcinoma associated with obstruction of bronchioles. Bronchocentric granulomatosis in some cases may represent an immunologic response to tumor detritus or lipid, as well as to mucus impaction.