Medical management of post-sublobar resection pulmonary granulomatous lesion: a report of two cases

TL;DR

Two patients with non-cancerous lung lesions near surgical staples were successfully treated with medications, showing that such lesions can be managed medically rather than surgically.

Contribution

Demonstrates that granulomatous lesions after sublobar resection can be effectively treated with medication, aiding in distinguishing them from cancer recurrence.

Findings

Corticosteroids and a COX-2 inhibitor reduced tumor size and symptoms in a patient with a granulomatous lesion.

Low-dose erythromycin effectively reduced a mycobacterium granuloma around a surgical staple.

Monitoring treatment response helps differentiate granulomas from tumor recurrence.

Abstract

Automatic stapling devices are commonly utilized in pulmonary resections, including sublobar segmentectomy. Large tumors can develop around the staple line, posing challenges in distinguishing them from cancer recurrence or inflammatory changes. In this report, we present two cases of symptomatic staple granulomatous lesion effectively managed with medications.

A 74-year-old man presented with a persistent cough and sputum production six years post-segmentectomy for a hamartoma in the left upper lobe. Chest computed tomography (CT) revealed a large tumor around the staple line. Laboratory investigations and bronchoscopic examination revealed no malignancy. The patient received corticosteroids and a cyclooxygenase-2 inhibitor; despite experiencing adverse reactions to steroids, both tumor size and respiratory symptoms were significantly reduced. The second case involved a 78-year-old woman who underwent pulmonary resection for suspected lung cancer. Despite a non-malignant tumor diagnosis, she reported a cough six months post-surgery. Chest CT revealed extensive shadow around the surgical staple, which was diagnosed as mycobacterium granuloma. Low-dose erythromycin induced inflammatory changes but effectively reduced the lesion.

Granulomatous lesions around the staple can be effectively managed with medication, and monitoring the treatment response proves valuable in distinguishing them from tumor recurrence post-pulmonary resection.

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