Abstract Background Inflammatory myofibroblastic tumor (IMT) is a rare pulmonary neoplasm that can mimic malignancy both radiographically and metabolically. The coexistence of fungal infection, particularly Blastomyces dermatitidis, is exceptionally uncommon and may complicate diagnosis and management. Case Presentation A 57-year-old male farmer and former smoker (30-40 pack-years) presented after an upper respiratory illness and was incidentally found to have a 4 cm left lower lobe mass. He reported mild cough without hemoptysis, chest pain, or systemic symptoms. He had experienced multiple prior episodes of “pneumonia,” treated with antibiotics. He denied travel outside Illinois but frequently worked unmasked during the harvest season. PET-CT showed a 4.2 × 3.1 cm hypermetabolic left lower lobe mass (SUV 19.7) without nodal uptake. He underwent VATS left lower lobectomy with mediastinal lymphadenectomy. Histopathology revealed a 4.9 cm inflammatory myofibroblastic tumor invading segmental bronchi and vascular walls, with three of fourteen lymph nodes positive for metastatic tumor. GMS and PAS-D stains demonstrated broad-based budding yeasts consistent with Blastomyces dermatitidis. The case was reviewed at tumor board and staged as T2bN1. Given low recurrence risk, chemotherapy was deferred. The patient was treated with oral itraconazole for blastomycosis and continues on imaging surveillance. Discussion Pulmonary IMTs represent 1% of lung tumors and can be intensely FDG-avid, mimicking malignancy. Occupational exposure to soil and organic matter may have predisposed to pulmonary blastomycosis, which in turn could contribute to local inflammation and tumorigenesis. Conclusion This case underscores the importance of histopathologic evaluation in hypermetabolic pulmonary lesions, especially in endemic fungal regions. This abstract is funded by: None
Sakaleshpur et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: