Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challenge

IntroductionLipoid pneumonia is a rare inflammatory disease characterized by an abnormal deposition of lipids in the alveoli. It may manifest as pulmonary consolidation, simulating primary lung cancer on radiological imaging and an increased uptake on fluorine-18-fluorodeoxy-D-glucose (FDG) positron...

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Main Authors: Shehab Mohamed, Luca Bertolaccini, Mariano Lombardi, Clementina Di Tonno, Angela Sabalic, Monica Casiraghi, Lorenzo Spaggiari
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-03-01
Series:Frontiers in Oncology
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Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2025.1538418/full
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author Shehab Mohamed
Luca Bertolaccini
Mariano Lombardi
Clementina Di Tonno
Angela Sabalic
Monica Casiraghi
Monica Casiraghi
Lorenzo Spaggiari
Lorenzo Spaggiari
author_facet Shehab Mohamed
Luca Bertolaccini
Mariano Lombardi
Clementina Di Tonno
Angela Sabalic
Monica Casiraghi
Monica Casiraghi
Lorenzo Spaggiari
Lorenzo Spaggiari
author_sort Shehab Mohamed
collection DOAJ
description IntroductionLipoid pneumonia is a rare inflammatory disease characterized by an abnormal deposition of lipids in the alveoli. It may manifest as pulmonary consolidation, simulating primary lung cancer on radiological imaging and an increased uptake on fluorine-18-fluorodeoxy-D-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT). The confirmed diagnosis can be achieved only by microscopic examination of cytological or histological samples.MethodsThis paper describes eight cases at a single center from 2016 to 2024 of lipoid pneumonia mimicking primary lung cancer and its risk factors. Samples were collected thanks to multidisciplinary evaluations using CT and FDG-PET/CT. The histopathological diagnoses were obtained with endobronchial ultrasound (EBUS), fine needle aspiration biopsy (FNAB), or, as a last resort, surgical resection.ResultsOur cohort of patients confirms that lung masses with fat density and irregular margins are lipoid pneumonia’s most common findings. However, it can also present as a solid mass with no fat density. This condition must always be appropriately evaluated through a multidisciplinary approach, especially when excluding a neoplastic origin.ConclusionIn this paper, we present the largest case series of lipoid pneumonia mimicking primary lung cancer from a single center reported in the literature so far. This case series highlighted the critical role of a multidisciplinary approach, including radiologists and pathologists, in differentiating lipoid pneumonia from malignancy to ensure optimal patient management.
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spelling doaj-art-0ff034d36cc54576b8c0012640d775cb2025-08-20T02:54:33ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-03-011510.3389/fonc.2025.15384181538418Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challengeShehab Mohamed0Luca Bertolaccini1Mariano Lombardi2Clementina Di Tonno3Angela Sabalic4Monica Casiraghi5Monica Casiraghi6Lorenzo Spaggiari7Lorenzo Spaggiari8Department of Thoracic Surgery, IEO, European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, ItalyDepartment of Thoracic Surgery, IEO, European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, ItalyDivision of Pathology, IEO, European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, ItalyDivision of Pathology, IEO, European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, ItalyDepartment of Thoracic Surgery, IEO, European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, ItalyDepartment of Thoracic Surgery, IEO, European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, ItalyDepartment of Oncology and Hemato-Oncology, University of Milan, Milan, ItalyDepartment of Thoracic Surgery, IEO, European Institute of Oncology Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, ItalyDepartment of Oncology and Hemato-Oncology, University of Milan, Milan, ItalyIntroductionLipoid pneumonia is a rare inflammatory disease characterized by an abnormal deposition of lipids in the alveoli. It may manifest as pulmonary consolidation, simulating primary lung cancer on radiological imaging and an increased uptake on fluorine-18-fluorodeoxy-D-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT). The confirmed diagnosis can be achieved only by microscopic examination of cytological or histological samples.MethodsThis paper describes eight cases at a single center from 2016 to 2024 of lipoid pneumonia mimicking primary lung cancer and its risk factors. Samples were collected thanks to multidisciplinary evaluations using CT and FDG-PET/CT. The histopathological diagnoses were obtained with endobronchial ultrasound (EBUS), fine needle aspiration biopsy (FNAB), or, as a last resort, surgical resection.ResultsOur cohort of patients confirms that lung masses with fat density and irregular margins are lipoid pneumonia’s most common findings. However, it can also present as a solid mass with no fat density. This condition must always be appropriately evaluated through a multidisciplinary approach, especially when excluding a neoplastic origin.ConclusionIn this paper, we present the largest case series of lipoid pneumonia mimicking primary lung cancer from a single center reported in the literature so far. This case series highlighted the critical role of a multidisciplinary approach, including radiologists and pathologists, in differentiating lipoid pneumonia from malignancy to ensure optimal patient management.https://www.frontiersin.org/articles/10.3389/fonc.2025.1538418/fulllipoid pneumonialung cancerdifferential diagnosisEBUSthoracic surgery
spellingShingle Shehab Mohamed
Luca Bertolaccini
Mariano Lombardi
Clementina Di Tonno
Angela Sabalic
Monica Casiraghi
Monica Casiraghi
Lorenzo Spaggiari
Lorenzo Spaggiari
Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challenge
Frontiers in Oncology
lipoid pneumonia
lung cancer
differential diagnosis
EBUS
thoracic surgery
title Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challenge
title_full Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challenge
title_fullStr Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challenge
title_full_unstemmed Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challenge
title_short Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challenge
title_sort unmasking the mimic lipoid pneumonia imitating primary lung cancer a case report series of a diagnostic challenge
topic lipoid pneumonia
lung cancer
differential diagnosis
EBUS
thoracic surgery
url https://www.frontiersin.org/articles/10.3389/fonc.2025.1538418/full
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