Pulmonary crystal-storing histiocytoma in a patient without a lymphoproliferative disorder

Our plain-English summary of Pulmonary crystal-storing histiocytoma in a patient without a lymphoproliferative disorder, by W.S. Lee, S.R. Kim, H. Moon, et al (The American Journal of the Medical Sciences, 2009).

The study

• Authors: W.S. Lee, S.R. Kim, H. Moon, Y.H. Choe, S.J. Park, H.B. Lee, G.Y. Jin, M.J. Chung, Y.C. Lee
• Journal: The American Journal of the Medical Sciences
• Published: 2009;338(5):421-4
• Type of article: Case report
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pulmonary crystal-storing histiocytoma is a very rare disorder and is characterized by infiltration of histiocytes with intracytoplasmic accumulation of crystallized immunoglobulins. It is usually associated with lymphoproliferative diseases or plasma cell dyscrasia. Here, we report a case of pulmonary crystal-storing histiocytoma in a 64-year-old man, presenting as a chronic pulmonary consolidation in the lung exposed to asbestos. Video-assisted thoracoscopic surgical biopsy displayed sheets of large, epithelioid histiocytes filled with a large number of needle-like crystals, showing the accumulation of crystallized polyclonal immunoglobulins. This lesion was consistent with crystal-storing histiocytosis or crystal-storing histiocytoma. With extensive clinical work-up, the current case was not associated with lymphoproliferative diseases. Herein, we present this extremely rare entity of pulmonary pathology, a pulmonary crystal-storing histiocytoma arising in the lung exposed to asbestos, and demonstrate the clinical, radiologic, and pathologic features of the tumor.

In plain English

This article was a case report from Chonbuk National University Medical School in South Korea. It described one patient with pulmonary crystal-storing histiocytoma, a rare lung lesion in which immune cells called histiocytes fill with crystallized antibodies (immunoglobulins). The patient was a 64-year-old man who had worked as a construction laborer exposed to asbestos for 20 years. After treatment for lung abscess and tuberculosis, a single area of consolidation measuring 45 by 26 by 40 mm remained in his right middle lobe. A thoracoscopic biopsy showed sheets of histiocytes filled with needle-like crystals that stained for several immunoglobulin types. Asbestos bodies were readily found within the lesion. Tests including serum protein electrophoresis and a bone marrow biopsy found no lymphadenopathy, lymphocytosis or bone lesion, and laboratory results were normal. The patient declined the recommended surgery. The authors said this was the second reported case in a person with an asbestos history. Based on previous reports, they wrote that it is likely there is no causal association between asbestos exposure and this condition. The article did not name an asbestos fiber type.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 64-year-old man with an unresolved consolidation in the right lung, reported by physicians at Chonbuk National University Medical School, Jeonju, South Korea
• Exposure: Occupational asbestos exposure as a construction laborer for 20 years; fiber type not stated
• Main results:
  • Contrast-enhanced chest CT showed a heterogeneously enhancing consolidation measuring 45 by 26 by 40 mm in the lateral segment of the right middle lobe
  • The biopsy showed sheets of large epithelioid histiocytes filled with many needle-like or rhomboid crystals
  • The crystals were immunoreactive for IgG and IgA heavy chains and for kappa and lambda light chains, with focal weak IgM staining (polyclonal)
  • Asbestos bodies were readily identified within the lesion, mainly in the alveoli and occasionally in macrophages
  • The work-up to exclude lymphoproliferative disease included serum protein electrophoresis and a bone marrow biopsy
  • No lymphadenopathy, lymphocytosis or bone lesion was found, and laboratory results were within normal limits
  • The patient declined the recommended surgical excision and chose symptomatic treatment only
  • The authors described this as the second reported pulmonary crystal-storing histiocytoma in a person with a history of asbestos exposure. Based on previous reports, they judged it likely that there is no causal association between asbestos exposure and the condition
• The authors' conclusion: The authors concluded that crystal-storing histiocytoma appears able to occur in the lung without evidence of an underlying clonal lymphoid proliferation, though its nature is unclear

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Consolidation, Biopsy, Epithelioid, Pathology.

Related studies

• Lymphoproliferative disorder in pleural effusion in a subject with past asbestos exposure — N. Hara, N. Fujimoto, et al. (2015)
• Lymphoproliferative conditions of the serosa — R. Attanoos (2012)
• Lymphoid and plasma cell malignancies: asbestos-related disorders of long latency — E. Kagan, R.J. Jacobson (1983)
• Combined pulmonary fibrosis and emphysema alters physiology but has similar mortality to pulmonary fibrosis without emphysema — M.D. Jankowich, S. Rounds (2010)
• Pulmonary function of nonsmoking female asbestos workers without radiographic signs of asbestosis — X.R. Wang, E. Yano, et al. (1998)
• Solitary pulmonary nodule in a patient without asbestos exposure — J.F. Turner, C. Gronbeck, et al. (1992)

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