Immunologic Research

, Volume 65, Issue 1, pp 375–385 | Cite as

Pulmonary hyalinizing granuloma: a multicenter study of 5 new cases and review of the 135 cases of the literature

  • Raphael Lhote
  • Julien Haroche
  • Loïc Duron
  • Nicolas Girard
  • Marie Pierre Lafourcade
  • Michel Martin
  • Hugues Begueret
  • André Taytard
  • Frédérique Capron
  • Philippe Grenier
  • Jean Charles Piette
  • Fleur Cohen-Aubart
  • Zahir Amoura
Mechanism in Autoimmunity

Abstract

Pulmonary hyalinizing granuloma (PHG) is a rare disease characterized by single or multiple benign lung nodules mimicking lung neoplasma. Histologic analysis reveals homogenous hyaline lamellae, usually surrounded by collection of plasma cells, lymphocytes and histiocytes in a perivascular distribution. The clinical and radiological findings have been described in small series, but the long-term outcomes have rarely been reported. The objectives were to describe the clinical, radiological and outcomes of PHG in new cases and through a literature review. Patients with PHG were found by a multicenter search among French departments of internal medicine, pulmonology and anatomo-pathology. Review of the literature was made through the National Library of Medicine’s MEDLINE database using keywords “hyalinizing granuloma.” Five news cases and 135 cases of the literature were found. There were 82 men and 57 women, mean age at the diagnosis 44.6 years (15–83). Patients were frequently asymptomatic (n = 39, 27.4 %). The nodule was unique in 37 cases (28.9 %) and multiple in 91 cases (71.1 %). 18FDG PET scan revealed hypermetabolism of the nodule in 9/15 cases (60 %). A systemic disease was associated in 65 cases (mainly mediastinal and retroperitoneal fibrosis, autoimmune, tumoral or infectious disease or thromboembolism). The outcomes were evaluated in 73 patients when follow-up was available: 14 patients had a surgical resection of the nodule. Forty-five patients did not receive any immunosuppressive drug. Among these patients, 2 improved, 29 were stable and 14 worsened. Corticosteroids were used as a monotherapy in 19 patients and led to radiological improvement in 8 cases, stabilization in 8 cases and worsening in 3 cases. Five patients were treated with corticosteroids and at least one immunosuppressive drug and 4 patients improved. PHG is a rare benign disease, mimicking lung neoplasma, frequently associated with systemic diseases.

Keywords

Hyalinizing granuloma Lung nodule 18FDG PET scan 

Abbreviations

BAL

Broncho-alveolar lavage

CT scan

Computerized tomography scanner

FEV1

Forced expiratory volume in one second

FVC

Forced vital capacity

HBV

Hepatitis B virus

HCV

Hepatitis C virus

HIV

Human immunodeficiency virus

MALT

Mucosa-associated lymphoid tissue

PHG

Pulmonary hyalinizing granuloma

SUV

Standard uptake value

18FDG PET

18 Fluorodeoxyglucose positron emission tomography

Notes

Acknowledgments

Mehdi Gharbi, Harika Salepcioglu, Toshikado Kaneta, Yojiro Shibata, Young Jiang carried out the translation of articles and bibliography search.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interests.

References

  1. 1.
    Benfield JR, Harrison RW, Moulder PV, Lyon ES, Graff PW. Bilateral nodular pulmonary granulomas and retroperitoneal fibrosis. JAMA. 1962;182:579–81.CrossRefPubMedGoogle Scholar
  2. 2.
    Engleman P, Liebow AA, Gmelich J, Friedman PJ. Pulmonary hyalinizing granuloma. Am Rev Respir Dis. 1977;115:997–1008.PubMedGoogle Scholar
  3. 3.
    Nazek M, Mandybur TI, Sawaya R. Hyalinizing plasmacytic granulomatosis. Am J Surg Pathol. 1988;12(4):308–13.CrossRefPubMedGoogle Scholar
  4. 4.
    Ulbright TM, Katsenstein ALA. Solitary necrotizing granulomas of the lung. Am J Surg Pathol. 1980;4:13–28.CrossRefPubMedGoogle Scholar
  5. 5.
    Peng M, Xu WB, Shi JH, Cai BQ, Tian XL, Liu T, et al. The diagnostic value of CT-guided percutaneous needle lung biopsy in diffuse parenchymal lung diseases. Zhonghua Jie He He Hu Xi Za Zhi. 2012;35(3):171–5.PubMedGoogle Scholar
  6. 6.
    Khalifa LG, Schimmel DH, Gamsu G. Multiple chronic benign pulmonary nodules. Radiology. 1976;121:275–9.CrossRefGoogle Scholar
  7. 7.
    Drasin H, Blume MR, Rosenbaum EH, Klein H. Pulmonary hyalinizing granulomas in a patient with malignant lymphoma, with development nine years later of multiple myeloma and systemic amyloidoisis. Cancer. 1979;44:215–20.CrossRefPubMedGoogle Scholar
  8. 8.
    Schlosnagle DC, Check IJ, Sewell CW, Plummer A, York RM, Hunter RL. Immunologic abnormalities in two patients with pulmonary hyalinizing granuloma. Am J Clin Pathol. 1982;78:231–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Dent RG, Godden D, Stovin PGI, Stark JE. Pulmonary hyalinizing granuloma in association with retroperitoneal fibrosis. Thorax. 1983;38:955–6.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chalaoui J, Grégoire P, Sylvestre J, Lefebvre R, Amyot R. Pulmonary hyalinizing granuloma: a cause of pulmonary nodules. Radiology. 1984;152:23–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Guccion JG, Rohatgi PK, Saini N. Pulmonary hyalinizing granuloma. Electron microscopic and immunologic studies. Chest. 1984;85(4):571–3.CrossRefPubMedGoogle Scholar
  12. 12.
    Maijub AG, Giltman LI, Verner JL, Peace RJ. Pulmonary hyalinizing granuloma. Ann Allergy. 1984;54:227–9.Google Scholar
  13. 13.
    Cerrina J, Grateau G, Piette JC, Godeau P, Merlier M. Medistinite fibreuse dite idiopathique. Chirurgie. 1986;112(5):367–78.PubMedGoogle Scholar
  14. 14.
    Youssem SA, Hochholzer L. Pulmonary hyalinizing granuloma. Am J Clin Pathol. 1987;87:1–6.CrossRefGoogle Scholar
  15. 15.
    Ikard RW. Pulmonary hyalinizing granuloma. Chest. 1988;93(4):871–2.CrossRefPubMedGoogle Scholar
  16. 16.
    Gans SJM, van der Elst W, Straks W. Pulmonary hyalinizing granuloma. Eur Respir J. 1988;1:389–91.PubMedGoogle Scholar
  17. 17.
    Zafisaona G, Clary C, Meseure D. Granulome pulmonaire hyalinizant: a propos d’un cas. Sem Hop Paris. 1988;64(44):2851–5.Google Scholar
  18. 18.
    Macedo EV, Adolph J. Pulmonary hyalinizing granulomas. J de l’ Assoc Can des Radiol. 1985;36:66–7.Google Scholar
  19. 19.
    Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 6-1989. A 57-year-old man with increasing dyspnea and a mediastinal mass. N Engl J Med. 1989;320(6):380–9. doi: 10.1056/NEJM198902093200608.
  20. 20.
    Van Custem O, Ledent C, Mairesse M. Le granulome hyalinisant du poumon. Rev Mal Respir. 1990;7:279–82.Google Scholar
  21. 21.
    Dominguez P, Sotelo T, Varela G, Perez P. Multiple hyalinizing granuloma of the lung. Rev Clin Esp. 1990;186(6):307–8.PubMedGoogle Scholar
  22. 22.
    Eschelman DJ, Blickman JG, Lazar HL, O’keane JC, Schechter M. Pulmonary hyalinizing granuloma: a rare cause of solitary pulmonary nodule. J Thorac Imaging. 1991;6(2):54–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Kuramochi S, Kawai T, Yakumaru K, Mikata A, Torikata C, Kasuga Y, et al. Multiple pulmonary hyalinizing granulomas associated with systemic idiopathic fibrosis. Acta Pathol Jpn. 1991;41:375–82.PubMedGoogle Scholar
  24. 24.
    Patel Y, Ishukawa S, MacDonnell KF. Pulmonary hyalinizing granuloma presenting as multiple cavitary calcified nodules. Chest. 1991;100:1720–1.CrossRefPubMedGoogle Scholar
  25. 25.
    Lhote F, Chapelon C, Piette JC, Andrien JM, Chomette G, Godeau P. Pulmonary hyalinizing granulomase reports. Rev Mal Respir. 1991;8:246–8.PubMedGoogle Scholar
  26. 26.
    Anazawa Y, Nagai H, Motomiya M, Isawa T, Saito Y, Takahashi T, et al. A case of pulmonary hyalinizing granuloma. Tohoku J Exp Med. 1992;167:39–45.CrossRefPubMedGoogle Scholar
  27. 27.
    Atagi S, Sakatani M, Akira M, Yamamoto S, Ueda E. Pulmonary hyalinizing granuloma with castleman’s disease. Intern Med. 1994;33:689–91.CrossRefPubMedGoogle Scholar
  28. 28.
    John PG, Rahman J, Payne CB. Pulmonary hyalinizing granuloma: an unusual association with multiple sclerosis. South Med J. 1995;88(10):1076–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Kido M, Kaiki A, Nagata N, Manabe H, Iwata Y. A case of pulmonary hyalinizing granuloma with its occupational history of dust exposure. J UOEH. 1995;17(1):31–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Banaschak S, Muller KM. The differential diagnosis of multiple pulmonary nodules–pulmonary hyalinizing granulomas. Pneumologie. 1996;50:211–4.PubMedGoogle Scholar
  31. 31.
    Ramirez J, Mehta JB, Taylor RA, Byrd RP, Roy TM. Symptomatic pulmonary hyalinizing granuloma. South Med J. 1998;91(9):867–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Gorini M, Forloni F, Pezzoli A, Pezzica E. Pulmonary hyalinizing granuloma. Limited form of wegener’s granulomatosis? Ann Ital Med Int. 1998;13:176–9.PubMedGoogle Scholar
  33. 33.
    Kadoyama C, Yokosuka T, Otsuji M, Suzuki M. Pulmonary hyalinizing granuloma diagnosed by thoracoscopy. Nihon Kokyuki Gakkai Z asshi. 1999;37(6):481–4.Google Scholar
  34. 34.
    Russel AFR, Suggit RIC, Kazzi JC. Pulmonary hyalinizing granuloma: a case report and literature review. Pathology. 2000;32:290–3.CrossRefGoogle Scholar
  35. 35.
    Laraki R, Wechsler B, Bourgeon B, Wechsler J, Charlotte F, Piette JC. Le granulome pulmonaire hyalinisant: à propos de deux observations originals avec localization cervicofaciale et orbitaire. Rev Med Interne. 2001;22:284–91.CrossRefPubMedGoogle Scholar
  36. 36.
    Ren Y, Raitz EN, Lee KR, Pingleton SK, Tawfik O. Pulmonary small lymphocytic lymphoma (mucosa-associated lymphoid tissue type) associated with pulmonary hyalinizing granuloma. Chest. 2001;120(3):1027–30.CrossRefPubMedGoogle Scholar
  37. 37.
    Zambudio AR, Calvo JR, Lanzas JT, Paricio PP. Granuloma hialinizante multiple pulmonar. Med Clin. 2001;116(4):157–9.CrossRefGoogle Scholar
  38. 38.
    Yang J, Liang Y, Liao S. Pulmonary hyalinizing granuloma: a case report and a review of the literature. Zhongua Jie He He Hu Xi Za Zhi. 2001;24(6):369–70.Google Scholar
  39. 39.
    Fujishama N, Takada T, Moriyama H, Saito Y, Suzuki E, Yoshiya K, et al. Pulmonary hyalinizing granuloma with massive infiltration of lymphocytes. Nihon kokyuki gakkai zasshi. 2001;39(12):924–9.Google Scholar
  40. 40.
    Hashimoto S, Fujii W, Takahashi T, Shiroshita K, Sakurai T, Ueda T, et al. Pulmonary hyalinizing granuloma with hydrinephrosis. Intern Med. 2002;41:463–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Wierzbsicka M, Kus J, Langfort R. A case of multiple pulmonary granuloma. Pneumonol Alergol Pol. 2002;70(1–2):97–101.Google Scholar
  42. 42.
    Khilnani GC, Kumar A, Gupta SD, Surendranath A, Sharma S. Pulmonary hyalinizing granuloma presenting with dysphagia. J Assoc Physicians India. 2003;51:519–21.PubMedGoogle Scholar
  43. 43.
    Gossot D, Fromont G, Galetta D, Debrosse D, Grunenwald D. Granulome pulmonaire hyalinisant avec fibrose médiastinale: une cause rare de dysphagie. Ann Chir. 2003;128:622–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Pinckard JK, Rosenbluth DB, Patel K, Dehner LP, Pfeifer JD. Pulmonary hyalinizing granuloma associated with aspergillus infection. Int J Surg Pathol. 2003;11(1):39–42.CrossRefPubMedGoogle Scholar
  45. 45.
    Wheen LC, Taylor GB. Pulmonary hyalinizing granuloma: an airway-acquired aetiology? Pathology. 2004;36(6):583–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Lvovsky D, Rosman J, Iliescu M. Pulmonary hyalinizing granuloma presenting as bilateral dense apical masses. Chest. 2004;126(4):950S–1S.CrossRefGoogle Scholar
  47. 47.
    Hantous-Zannad S, Zidi A, Boussema F, Mestiri I, Ben Hassine R, Cherif O, et al. Le granulome pulmonaire hyalinisant: à propos de deux cas. J Radiol. 2004;85:1074–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Shinohara T, Kanko T, Miyazawa Nakatani Y, Nishiyama H, Shoji A, et al. Pulmonary hyalinizing granuloma with laryngeal and subcutaneous involvement: report of a case successfully treated with glucocorticoids. Intern Med. 2004;43(1):69–73.CrossRefPubMedGoogle Scholar
  49. 49.
    O’Reilly KMA, Boscia JA, Kaplan KL, Sime PJ. A case of steroid responsive pulmonary hyalinizing granuloma: complicated by deep venous thrombosis. Eur Respir J. 2004;23:954–6.CrossRefPubMedGoogle Scholar
  50. 50.
    Esme H, Ermis SS, Fidan F, Unlu M, Dilek FH. A case of pulmonary hyalinizing granuloma associated with posterior uveitis. Tohoku J Exp Med. 2004;204:93–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Potat S, Nicholson AG, Fisher C, Harmer C, Moskovic E, Murday VA, et al. Pulmonary masses presenting 11 years after abdominal surgery. Respiration. 2004;71:295–7.CrossRefGoogle Scholar
  52. 52.
    Vezzani G, Cavazza A, Rosi G, Pasquinelli G, Avanzini P, Asioli S, et al. Pulmonary hyalinizing granuloma. Clinicopathologic study of 2 cases, with some original ultrastructural observations and review of the literature. Pathologica. 2004;96:25–8.Google Scholar
  53. 53.
    Satti MB, Batouk AA, Abdelaziz MM, Ahmad MF, Abdelall MA. Pulmonary hyalinizing granuloma. Bilateral pulmonary nodules associated with chronic idiopathic thrombocytopenic purpura. Saudi Med J. 2005;26(9):1459–63.PubMedGoogle Scholar
  54. 54.
    Agrawal D, Deshpande R, Maheshwari S, Patel A, Udwadia ZF. Pulmonary hyalinizing granuloma with ureteric fibrosis: a case report and review of relevant literature. Indian J Chest Dis Allied Sci. 2006;48:283–5.PubMedGoogle Scholar
  55. 55.
    Basoglu A, Findik S, Celik B, Yildiz L. Pulmonary hyalinizing granuloma mimicking lung carcinoma. Thorac Cardiovasc Surg. 2006;54:276–88.CrossRefGoogle Scholar
  56. 56.
    Fidan A, Ocal Z, Caglayan B, Dogusoy I, Gumrukcu G. An unusual cause of pulmonary nodules: pulmonary hyalinizing granuloma with recurrence. Respir Med Extra. 2006;2:112–5.CrossRefGoogle Scholar
  57. 57.
    Ucvet A, Tozum H, Gursoy S, Gulle AA, Yaldiz S, Aydogdu DZ. Pulmonary hyalinizing granuloma mimicking pulmonary carcinoma. Tuberkuloz ve toraks dergisi. 2006;54(1):71–4.Google Scholar
  58. 58.
    Wang WZ, Liu HR, Guo LN. Pulmonary hyalinizing granuloma: report of 2 cases. Zhomghua bing li xue za zhi. 2006;35(8):505–7.Google Scholar
  59. 59.
    Colen RR, Nagle JA, Wittram C. Radiologic-pathologic conference of the Massachusetts general hospital. Am J Roentgenol. 2007;188:w115–6.Google Scholar
  60. 60.
    Winger DI, Spiegler P, Trow TK, Goyal A, Yu H, Yung E, et al. Radiology-pathology conference: pulmonary hyalinizing granuloma associated with lupus-like anticoagulant and Morvan’s syndrome. Clin Imaging. 2007;31:264–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Na KJ, Song SY, Kim JH, Kim YC. Subpleural pulmonary hyalinizing granuloma presenting as a solitary pulmonary nodule. J Thorac Oncol. 2007;2(8):777–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Young AS, Binkovitz LA, Adler BH, Nicol KK, Rennebohm RM. Pulmonary hyalinizing granuloma and retroperitoneal fibrosis in an adolescent. Pediatr Radiol. 2007;37:91–5.CrossRefPubMedGoogle Scholar
  63. 63.
    Shibata Y, Kobayashi T, Hattori Y, Matsui O, Gabata T, Tamori S, et al. High-resolution CT findings in pulmonary hyalinizing granuloma. J Thorac Imaging. 2007;22(4):374–7.CrossRefPubMedGoogle Scholar
  64. 64.
    Chia J, Tapson V. Pulmonary hyalinizing granuloma presenting with hemoptysis and hilar mass. Chest. 2007;132(4 Supplement):707S.Google Scholar
  65. 65.
    Liu T, Kyrollos M, Kravcik S. Pulmonary hyalinizing granuloma in HIV/AIDS. Can J Infect Dis Med Microbiol. 2007;18(5):305–7.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Ben GI, Ennaifer R, Haouet S, Khanfir M, Lamloum M, Miled M, et al. Pulmonary hyalinizing granuloma revealed by a pituitary gland diffusion. La revue de medicine interne. 2008;29:54–7.CrossRefGoogle Scholar
  67. 67.
    Preuss J, Woenckhaus C, Thierauf A, Strehler M, Madea B. Non-diagnosed pulmonary hyalinizing granuloma (PHG) as a cause of sudden unexpected death. Forensic Sci Int. 2008;179:e51–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Xu Z, Bethune D, Manos D, Doyle A, Henteleff H, Johnston M, et al. Pulmonary hyalinizing granuloma. J Peking Univ. 2009;41(4):463–8.Google Scholar
  69. 69.
    Khalid I, Stone C, Kvale P. A unique case of pulmonary hyalinizing granuloma associated with FDG-avid PET scan and deep venous thrombosis. J Bronchol Pulmonol. 2009;16(2):108–11.CrossRefGoogle Scholar
  70. 70.
    Kaneta T, Saito A, Akiyama T, Takahashi Y, Kudou K. A case of pulmonary hyalinizing granuloma with high-grade uptake on FDG-PET mimicking metastatic lung cancer. Nihon Kokyuki Gakkai Zasshi. 2009;47(10):953–9.PubMedGoogle Scholar
  71. 71.
    Arruda GDS, Carvalho PCR, Andrade MPG, Cusmanich MC, Bandeira G, Tozaki FSP. Recurrent pulmonary hyalinizing granuloma. J Bras Pneumol. 2010;36(5):662–5.CrossRefPubMedGoogle Scholar
  72. 72.
    Brandao V, Marchiori E, Zanetti G, Abdalla G, Ventura N, Constantino CL et al. Hyalinizing granuloma: an unusual case of a pulmonary mass. Case reports in medicine. 2010 Epub 2010 June 14.Google Scholar
  73. 73.
    Lien CT, Yang CJ, Yang SF, Chou SH, Huang MS. Pulmonary hyalinizing granuloma mimicking multiple lung metastases. J Thorac Imaging. 2010;25:w36–9.PubMedGoogle Scholar
  74. 74.
    Boutayeb L, Gen-hijos M, Mayayo E. Pulmonary hyalinizing granuloma. Arch Bronconrumol. 2012;48(9):342–6.Google Scholar
  75. 75.
    Chapman EM, Gown A, Mazziotta R, Churg A. Pulmonary hyalinizing granuloma with associated elevation in serum and tissue IgG4 occurring in a patient with a history of sarcoidosis. Am J Surg Pathol. 2012;36:774–8.CrossRefPubMedGoogle Scholar
  76. 76.
    Rahatullah A, Waheed Z, Khan JA. Nasir-ud-Din. Pulmonary hyalinizing granuloma: a rare pulmonary disorder. J Pak Med Assoc. 2012;62(5):493–5.PubMedGoogle Scholar
  77. 77.
    Matsuoka K, Imanishi N, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Pulmonary hyalinizing granuloma detected in a family member after confirmation of tuberculosis in his father. Ann Thorac Cardiovasc Surg. 2013 July 31. [Epub ahead of print].Google Scholar
  78. 78.
    Coleman C, Nassar A, McComb B. Pulmonary hyalinizing granuloma associated with idiopathic thrombocytopenic purpura. J Cin Imaging Sci. 2014;4:8. doi: 10.4103/2156-7514.127835.Google Scholar
  79. 79.
    Ussavarungsi K, Khoor A, Jolles HI, Mira-Avendano I. A 40-year-old woman with multiple pulmonary nodules. Chest. 2014;146(6):e198–203.CrossRefPubMedGoogle Scholar
  80. 80.
    Westhoff M, Litterst P, Albert M, Welim B. Pulmonary hyalinizing granuloma. Pneumologie. 2015;69:30–5.CrossRefPubMedGoogle Scholar
  81. 81.
    Düzgün N, Kurtipek E, Esme H, Eren Karanis Mİ, Tolu İ. Pulmonary hyalinizing granuloma mimicking metastatic lung cancer. Case Rep Pulmonol. 2015;2015:610417. doi: 10.1155/2015/610417.Google Scholar
  82. 82.
    Rodriguez-Muguruza S, Holgado S, Olivé A. Pulmonary Hyalinizing granuloma associated with Sjögren syndrome and ANCA MPO vasculitis. Joint Bone Spine. 2015;82:66–73.CrossRefGoogle Scholar
  83. 83.
    Ceresini G, Urban ML, Corradi D, et al. Association between idiopathic retroperitoneal fibrosis and autoimmune thyroiditis: a case-control study. Autoimmun Rev. 2015;14:16–22.CrossRefPubMedGoogle Scholar
  84. 84.
    Doria A, Sarzi-Puttini P, Shoenfeld Y. Infections, rheumatism and autoimmunity: the conflicting relationship between human and their environment. Autoimmun Rev. 2008. doi: 10.1016/j;autrev.2008.07.014.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Raphael Lhote
    • 1
  • Julien Haroche
    • 1
    • 2
  • Loïc Duron
    • 1
  • Nicolas Girard
    • 3
  • Marie Pierre Lafourcade
    • 4
  • Michel Martin
    • 4
  • Hugues Begueret
    • 5
  • André Taytard
    • 6
  • Frédérique Capron
    • 2
    • 7
  • Philippe Grenier
    • 2
    • 8
  • Jean Charles Piette
    • 1
    • 2
  • Fleur Cohen-Aubart
    • 1
    • 2
  • Zahir Amoura
    • 1
    • 2
  1. 1.Service de Médecine Interne 2, Centre National de Référence Maladies auto-immunes Systémiques Rares, AP-HPGroupe Hospitalier Pitié-SalpêtrièreParis Cedex 13France
  2. 2.Université Pierre et Marie Curie, Paris VISorbonnes UniversitésParisFrance
  3. 3.Service de Pneumologie, Centre National de Référence des Maladies Pulmonaires Rares Centre Expert National associé du Réseau RYTHMIC Tumeurs Thymiques et CancerHôpital Louis PradelLyonFrance
  4. 4.Service de PneumologieCentre Hospitalier d’AngoulêmeAngoulêmeFrance
  5. 5.Service d’Anatomo-PathologieCentre Hospitalier de PessacPessacFrance
  6. 6.Service de PneumologieCentre Hospitalier de PessacPessacFrance
  7. 7.Service d’Anatomo-pathologie, AP-HPGroupe Hospitalier Pitié SalpêtrièreParisFrance
  8. 8.Service de Radiologie, AP-HPGroupe Hospitalier Pitié SalpêtrièreParisFrance

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