Chickenpox-related pulmonary granulomas in immunocompetent adults: Clinicopathologic and molecular features of an underrated occurrence

Giulio Rossi, Alberto Cavazza, William Gennari, Alessandro Marchioni, Paolo Graziano, Antonella Caminati, Maria Cecilia Mengoli, Rita Magnani, Thomas V. Colby

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Pulmonary granulomas represent a common inflammatory reaction to several lung infective or noninfective diseases. However, little is known about the histology and clinical presentation of chickenpox-related granulomas in immunocompetent subjects. We collected a series of 8 adult patients (mean age, 40 y; range, 33 to 53 y) with several bilateral pulmonary granulomas incidentally discovered after imaging studies. All patients were asymptomatic and had experienced a varicella-zoster virus (VZV) infection as adults but were clinically suspected to have a metastatic neoplasm of unknown origin. Chest computed tomography scan revealed numerous, tiny (few millimeters to 1 cm in size) nodules randomly dispersed through the lungs. Positron emission tomography scan performed in 4 patients was negative. All patients underwent video-assisted thoracoscopic surgical resection and were still alive and well. At histology, granulomas consisted of well-defined, rounded, small nodules centered by a deeply eosinophilic, acellular necrosis rimmed by lamellar dense collagen and a chronic inflammatory infiltrate with or without multinucleated giant cells. Chickenpox-related granulomas were included in the differential diagnosis along with several other granulomatous diseases. Polymerase chain reaction-based molecular analysis for VZV performed on paraffin sections detected VZV DNA in all 8 cases. By contrast, 85 cases of pulmonary granulomas of different etiologies were simultaneously studied by molecular analysis with negative results. Pathologists should be familiar with the peculiar morphologic appearance of chickenpox-related granulomas. A careful search for a history of VZV infection in adulthood and molecular studies may be very helpful in confirming the diagnosis.

Original languageEnglish (US)
Pages (from-to)1497-1502
Number of pages6
JournalAmerican Journal of Surgical Pathology
Issue number10
StatePublished - Oct 2012


  • PCR
  • chickenpox
  • granuloma
  • lung
  • varicella-virus

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine


Dive into the research topics of 'Chickenpox-related pulmonary granulomas in immunocompetent adults: Clinicopathologic and molecular features of an underrated occurrence'. Together they form a unique fingerprint.

Cite this