Nodular histiocytic/mesothelial hyperplasia (NHMH) is a benign localized alteration, first
described in 1975 by Rosai in the hernia sac [1]. Few pulmonary cases have been reported in literature
[2–6]. Sometimes it has been reported in the pericardium [7,8] or presenting as an inguinal
mass [9]. The ‘mesothelial/monocytic incidental cardiac excrescence’, first described by Weinot et al.
in 1994 [10] is now considered a similar lesion to NHMH [11].
It consists of a reactive proliferation of histiocytes and mesothelium secondary to chronic irritation
and it has been observed in pleura-damaging processes, such as pneumothorax [5], or as consequence
of cardiac catheterization, inflammation, mechanical or tumor stimulation [11].
The rarity of NHMH and the moderate cytological atypia often present, make this lesion difficult
to diagnose. It can be easily confused with primary mesothelial lesions and neoplasms such
as adenocarcinomas, granulosa cell tumors or Langerhans’ histiocytosis.
We report a case of pleural NHMH in a patient with a subphrenic abscess, in which no pulmonary
pathogenic noxa was evident. We hypothesize a transdiaphragmatic chronic irritation as a
pathogenetic mechanism underlying NHMH