Staged traditional Chinese medicine treatment for suspected pulmonary inflammatory pseudotumor with progressive lesion reduction: a case report and literature review

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Background Pulmonary inflammatory pseudotumor (PIPT) is a rare benign lesion often indistinguishable from malignancy on imaging. For indeterminate solid masses exceeding 3 cm, surgical resection is generally recommended. Conservative management strategies for patients who decline surgery remain poorly defined. Case presentation A 55-year-old male presented with a 3.4 cm × 2.6 cm irregular mass in the right lower lobe with lobulation and small bubble signs. CT-guided percutaneous biopsy revealed fibrous tissue proliferation with lymphoplasmacytic infiltration and epithelioid granulomas without necrosis. Immunohistochemistry showed TTF-1 (+), NapsinA (+), P40 (focally +), P53 (wild-type pattern), CEA (−), Ki67 (∼10%), KP-1 (+), CD38 (+), IgG (+), and IgG4 (focally +); special stains were negative. An inflammatory process consistent with PIPT was suspected; however, ALK, SMA, and Vimentin were not tested, and definitive distinction from pulmonary inflammatory myofibroblastic tumor (PIMT) could not be established. The patient declined surgery and received staged traditional Chinese medicine (TCM) treatment: early-phase therapy focused on dispersing wind and ventilating the lung; subsequent phases transitioned to supplementing Qi (vital energy), resolving phlegm, and activating blood circulation. Serial CT (same institution/scanner) demonstrated progressive lesion reduction to 2.5 cm × 1.8 cm at 5 months and 1.9 cm × 0.7 cm at 10 months, with corresponding symptomatic improvement. Conclusion Spontaneous regression cannot be excluded. However, the absence of corticosteroid use, the pre-treatment stability of the lesion, and the stepwise reduction observed during successive treatment phases are temporally consistent with a treatment-associated response. Staged TCM syndrome differentiation may warrant further investigation as a conservative option for selected patients with inflammatory pulmonary lesions who decline surgery.