Solitary lung lesions in Wegener's granulomatosis. Pathologic findings and clinical significance in 25 cases.

We describe 25 cases of Wegener's granulomatosis presenting with solitary lung lesions to compare the clinical and pathologic findings in these cases with those of the more common multifocal disease and also to evaluate the clinical significance of solitary lung lesions occurring in the absence of extrapulmonary disease. The clinical findings in our patients with solitary Wegener's were similar to those in generalized disease. Men were affected slightly more often than women, and the average age of onset was 53 years. Likewise, no major pathologic differences were found between solitary and multifocal disease. Classic necrotizing granulomatous inflammation and necrotizing vasculitis were the most common findings, although other variants were occasionally encountered, including the eosinophilic variant (two cases), the bronchocentric variant (one case), and small-vessel vasculitis and capillaritis (one case). Three cases had prominent areas of bronchiolitis obliterans-organizing pneumonia. Progressive disease occurred in all seven patients who manifested solitary lung lesions without extrapulmonary involvement and were not treated because the diagnosis was initially unrecognized. Pathologists need to be alert to the possibility of Wegener's granulomatosis causing solitary lung lesions because treatment should be promptly instituted.