Abstract

A case of cholesterol pneumonitis caused by the rupture of anterior mediastinal dermoid cyst to the right lung was to be reported and a review of the literature related to this case was presented in history and histopathology. This would be the second case found in Korea. A 43 year-old Korean housewife was admitted to the department of chest surgery in Busan National University Hospital in August 10, 1974, because of severe coughing and blood tinged sputum. About 4 months before admission, she had treated at local clinics for 3 months under diagnosis of the pulmonary abscess with no effects. On physical examination at admission, the patient appeared poor in nutrition. The temperature was 37.2℃, the pulse 80, and the respiration 20 per minute. The blood pressure Ivas 110/70. There was mildly anemic in both conjunctivae. The face was mildly edematous and pale. There was no lymphadenopathy. In the right lower lung field, there was decreased in breathing sound. The hematocrit was 29 percent and the white blood cell count was 4,800 per cubic mm (neutrophil 53%, lymphocyte 34%, and eosinophil 13%). The bleeding time and coagulation time were normal. The cytological examination was negative. The x-ray examination of the chest revealed increased density in the right lower lung field. The radiologist suggested pulmonary abscess. The bronchogram showed the complete obstruction of the right main bronchus with irregular and shouldering filling defect in the proximal portion of the right main bronchus and hazziness in the mid and lower lung fields. So, the radiologist suggested malignancy of the lung. The right lobectomy was performed. Grossly, there was seen a gray white, firm, spherical mass attached at the middle and lower portion of the right lung. The mass measured about 6 cm. in the great diameter and had gray white, relative smooth surface. On sectioning, the half of the mass invaded into the one third to two thirds of the middle and lower lobes of the right lung. And, there was noted the tumor separated by the thin capsule-like fibrous tissue. The inner surface of the cystic mass was smooth and resembled that of the skin. There was noted a few of mamma-like projecting, adult thumb to small finger-tip sized masses from the inner surface of the cyst. There was presented a few of hairs occurring from the any mamma-like masses. In the cystic cavity, there was in part noted thick, yellow white sebaceous material. The lung tissue about the neoplasm was subcrepitant and revealed scattered small yellow-brown to yellow consolidation without cavity. No obstruction of the main bronchus was seen and some of the wall of the small bronchi became thickened out, while others were mildly dilated and contained sebaceous. material. The pulmonary artery was markedly dilated. Histologically, the sections from the lung tissue about the cystic tumor showed scattered and isolated granulomata in the lung tissue. The granulomata were composed of foamy macrophages, small round cells and fibroblasts with many foreign body giant cells. Some of the giant cells contained lipoid materials. The alveoli were filled with foamy cells and multinucleated foamy giant cells and sebaceous materials. The alveolar septum became thickened out by the infiltrate of inflammatory cells, chiefly macrophages and the proliferating fibroblasts and fibrocytes. The foamy macrophages had central or somewhat eccentrical small nuclei and relatively uniform vacuoles of lipid in the cytoplasm. The vacuolated material was stained as red or red-brown color on oil red O stain and dark brown on Ogamoto’s cholesterol stain. The sections from the cystic tumor showed typical dermoid cyst.