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Chronic granulomatous disease (CGD) is an uncommon primary immune deficiency caused by phagocytes defective in oxygen metabolite production. It results in recurrent bacterial or fungal infections. Herein, we present a case of CGD with a large pulmonary granuloma in a neonate and review the imaging findings. The patient was a 24-day-old neonate admitted to the hospital with fever. A round opacified lesion was identified on the chest radiograph. Subsequent CT and MRI revealed a round mass with heterogeneous enhancement in the right lower lobe. There were foci of diffusion restriction in the mass. Surgical biopsy of the mass revealed chronic granuloma. Finally, the neonate was diagnosed with CGD caused by mutation of the gp91phox gene. Herein, we present the clinical and imaging findings of this unusual case of CGD.

Non-human primate models of Tuberculosis (TB) are one of the most commonly used within the experimental TB field because they closely mimic the whole spectrum of disease progression of human TB. However, the early cellular interactions of the pulmonary granuloma are still not well understood. The use of this model allows investigation into the early interactions of cells within pulmonary granulomas which cannot be undertaken in human samples. Pulmonary granulomas from rhesus and cynomolgus macaques from two timepoints post infection were categorised into categories 1 – 6 (early to late stage granulomas) and immunohistochemistry was used to identify CD68+ macrophages, CD3+ T cells and CD20+ B cells. Multinucleated giant cells and acid-fast bacilli were also quantified. At week four post infection, cynomolgus macaques were found to have more CD68+ cells than rhesus in all but category 1 granulomas. Cynomolgus also had a significantly higher percentage of CD20+ B cells in category 1 granulomas. At week twelve post infection, CD68+ cells were most abundant in category 4 and 5 granulomas in both species; however, there were no significant differences between them. CD3+ T cells and CD20+ B cells were significantly higher in the majority of granuloma categories in cynomolgus compared to rhesus. Multinucleated giant cells and acid-fast bacilli were most abundant in categories 5 and 6 at week 12 post challenge in both species. This study has identified the basic cellular composition and spatial distribution of immune cells within pulmonary granulomas in both rhesus and cynomolgus macaques over time. The data from this study will add to the knowledge already gained in this field and may inform future research on vaccines and therapeutics for TB.

This chapter opens with how to evaluate the solitary pulmonary nodule, presenting numerous imaging findings that can suggest whether it is benign or malignant. It then describes various benign and malignant pulmonary neoplasms and the three major routes for metastases (hematogenous, lymphangitic, and direct spread).

Objective: The aim of this report is to describe a case with Aspergillus vertebral osteomyelitis complicating pulmonary granuloma in an immunocompetent adult. Clinical Presentation and Intervention: A 53-year-old male patient was found to have lesions on lumbar vertebra 5 months after thoracoscopic resection of pulmonary granuloma that lacked a definite etiology. Three operations on the lumbar lesions were performed successively; however, an Aspergillus infection was not confirmed until hyphae were clearly detected at the last surgery. The patient was treated with voriconazole and recovered well. Conclusion: This case shows that simultaneous occurrence of granulomatous nodules in the lung and vertebral lesions should raise suspicion of aspergillosis, even in immunocompetent patients.

Background and objective Previous studies have demonstrated increases of inflammatory mediators in sarcoidosis while epidemiological studies have also demonstrated an association with increased fungi exposure. This study measured the level of β-glucan in the lungs and of inflammatory mediators in serum, and correlated both with the extent of pulmonary granuloma infiltration. Methods This is a cross-sectional study of 98 patients with sarcoidosis and 26 controls. β-glucan, a cell wall constituent of fungi, was measured in bronchoalveolar lavage. Inflammatory mediator levels were determined in serum. The extent of granuloma infiltration was estimated on the chest X-ray. Exposure to fungi at home was determined by taking air samples in bedrooms and analysing for the presence of β-N-acetylhexosaminidase. Results Significantly, higher levels of β-glucan were found in broncho-alveolar lavage in subjects with sarcoidosis as compared with controls. There were significant positive relationships between the extent of granuloma infiltration and the levels of the different inflammatory mediators, except for interleukin-10. Domestic fungal exposure was higher among subjects with sarcoidosis. Conclusions This is the first time that a specific agent, previously suspected to be related to the risk of sarcoidosis, has been detected in the lung of subjects with sarcoidosis and related to the levels of inflammatory mediators and the degree of home exposure to fungi. The results suggest that exposure to fungi should be explored when investigating patients with sarcoidosis.

患者は57歳女性．2000年12月に肺癌に対し，胸腔鏡補助下右S3区域切除施行．病理診断は高分化型腺癌，Stage IAであった．術後4年目の胸部X線，CTにて右上葉に5×5cmの腫瘤陰影を認めた．右肺癌再発を疑い胸腔鏡下手術を行った．右上葉に臓側胸膜の引きつれを伴う弾性硬の腫瘤を認めた．術中迅速病理検査では悪性所見は得られなかったが，肉眼所見では悪性が強く疑われたため，右上中葉切除を行った．切除標本肉眼的所見では腫瘤は5.5×5.0cm，割面は白色，周囲との境界は明瞭で，内部に黄緑色の膿汁の貯留を認めた．切除標本の軟X線写真にて，病変部の辺縁にほぼ一致して前回手術時のステープルラインを認めた．病理組織学的検査では肉芽腫形成を認めた．膿汁の培養からMycobacterium aviumが検出された．以上から自験例を肺癌術後のステープルラインに発生した非定型抗酸菌症を伴う肺肉芽腫と判断した．

Macrophages and α-smooth muscle actin immunopositive myofibroblasts are thought to be crucial cells in granuloma formation. In this study, the reactive cell kinetics was investigated in Sephadex bead-induced rat pulmonary granulomas (1mg/ml saline/head; intravenously) from l hour to 90 days after the injection. Intravenously administered Sephadex beads occluded pulmonary arteries and caused granulomatous pulmonary arteritis. The inflammatory cells appeared first around the trapped beads and then granuloma lesions developed within 24 hours. Three days later, the granulomas mainly consisted of neutrophils, macrophages, eosinophils, and giant cells. Immunohistochemically, the number of ED1-positive macrophages quickly increased 24 hours after the injection, and a large number of macrophages were still found 3 days after the injection. Alpha-smooth muscle actin immunopositive myofibroblasts increased in numbers from 3 to 7 days after theinjection. These results indicate that the appearance of myofibroblasts in pulmonary granulomas might be mediated by macro-phages, which were the most predominant inflammatory cells in the present pulmonary granuloma.

In patients with suspicion of lung malignancy, FDG PET/CT is frequently used as a diagnostic and staging imaging modality. However, false positive findings are not uncommon. We demonstrate a case with FDG-avid pulmonary nodules, mimicking lung cancer. After histopathological examination they appeared to be the result of persistent inflamed tissue, due to talcage pleurodesis, which occurred 48 years ago. We concluded that, nearly five decades after talcage pleurodesis, there can still be an ongoing inflammation reaction in the pleurae, which can be detected by FDG PET/CT.

In order to evaluate the role of the T cell function and T cell subsets on murine pulmonary granuloma reconstruction, histological and immunohistological analyses were done during serial studies on murine pulmonary granuloma formation induced by intratracheal administration of antigen binding Cepharose 4B beads. This granuloma formation showed antigen specific pattern and the most vigorous responce showed on the time at 72 hour after challenge.In the induction phase, Thy-1 positive and Lyt 1 positive T cells seemed dominant around beads. However, in the effector phase, i.e., 72-168 hour after beads challenge, Thy-1 positive and Lyt 2 positive T cells were dominant in peripheral protions of granuloma. This result showed that cytototoxic T cell would play an important role on the reconstruction of granulomatous lesions.

Pulmonary granulomas were induced in rabbits with Freund’s complete adjuvant. Histologic alterations, the mitotic index and Feulgen-DNA amounts determined by a cytophotometric method were studied. The mitotic index and DNA amounts increased significantly within the first hours and reached peak values on the 3rd day, then showed a tendency to decrease after the 7th day. After the 3rd day, a certain dissociation was noted between the mitotic index and Feulgen-DNA amount. The change in Feulgen-DNA content reflects the functional alterations that characterize pulmonary granuloma.

Anti-rabbit alveolar macrophage goat serum (AMS), adsorbed of hemolysins and hemagglutinins, exhibited complement-dependent cytotoxicity for the following rabbit target cells: alveolar macrophages, thymocytes, and kidney (RK-13) cells. The intravenous injection of AMS, sufficient to reduce markedly the dermal tuberculin reaction in BCG-sensitized rabbits, did not suppress the development of BCG-induced chronic and accelerated pulmonary granulomas. These observations are discussed in relation to delayed sensitivity, allergic granuloma formation, and cell-associated immunity.

The relationship between dermal delayed hypersensitivity (DH) and granulomatous hypersensitivity was studied in rabbits sensitized with killed mycobacteria. Specific antigen challenge of sensitized animals resulted in extensive pulmonary granulomatous inflammation and induced suppression of both dermal DH and dermal granuloma formation. Whereas suppression of DH was concomitant with pulmonary granuloma formation, as is the case in a number of granulomatous diseases, a causal relationship between the two did not exist. Both DH and dermal granulomatous hypersensitivity were significantly suppressed whether or not the antigen challenge was of a granulomagenic (particulate) or nongranulomagenic (soluble) form. The data presented indicate that granulomatous hypersensitivity and DH are selectively suppressed with regard to different anatomical sites.

An infarcted pulmonary granuloma meeting the criteria of a “coin lesion” in a 44-year-old man is attributed to the presence of a horse bot, Gasterophilus sp. (probably a second-stage larva of Gasterophilus intestinalis ), on the basis of identifiable remains in sections of the lesion. This appears to be a unique and exceptional case of a horse bot causing myiasis as an adventitious and unsuccessful parasite in the human lung. While the occurrence can be rationalized biologically and pathologically, confirmatory evidence of the suggested course of events leading to the formation of the lesion was not obtained.