Analysis of Clinical Characteristics of 35 Cases of Pulmonary Sclerosing Pneumocytoma / 中国肺癌杂志

BACKGROUND@#Pulmonary sclerosing pneumocytoma (PSP) is rare benign lung tumor which usually develops in middle-aged women without typical clinical and imaging findings. PSP consists of two basic cell types (surface cubic epithelial cells and round mesenchymal cells) and four histological types (hemorrhagic, sclerotic, solid and papillary). It grows slowly, but it can metastasize to distant organs. The pathology before surgery is easily misdiagnosed. This study aims to improve clinicians' understanding of PSP by discussing the clinical characteristics of the disease.@*METHODS@#This represents a retrospective study of thirty-five patients diagnosed with pulmonary sclerosing pneumocytoma by pathological examination from January 2011 to December 2019.@*RESULTS@#A total of 35 patients in this study, 12 cases were male and 23 cases were female, the average age is 51 years old. 7 cases were discovered accidentally by physical examination or routine chest computed tomography (CT), and 28 cases were found due to symptoms such as cough, sputum, hemoptysis and chest pain. The imaging changes is mainly featured with isolated or clear circular or round-like single nodule and lump in the lungs. In this group, 12 cases underwent percutaneous lung biopsy, only 7 cases were diagnosed with PSP. A total of 28 patients underwent surgery, 24 cases underwent rapid frozen pathological biopsy, only 5 cases diagnosed with PSP. Postoperative pathological examination results shows that 1 case was diagnosed with keratotic squamous cell carcinoma with partial PSP, and the rest were diagnosed with PSP. The surgical and non-surgical patients were followed up for 1 to 8 years after discharge, and the overall recovery was good. The patients were no recurrence and metastasis on chest CT review.@*CONCLUSIONS@#PSP is a clinically rare benign lung tumor, which is more common in middle-aged women. The clinical manifestations and imaging features are lack of significance. Percutaneous lung puncture pathological examination and intraoperative rapid frozen pathological sections often leads to misdiagnosis. Final diagnosis relies on postoperative pathological work-up for most cases.

Sclerosing pneumocytoma with metastasis to the mediastinal and regional lymph nodes

Sclerosing pneumocytoma (SP) is an uncommon benign tumor, and metastasis of SP has been rarely reported. Here, we report the case of a 26-year-old woman with surgically confirmed SP. The tumor diameter was 40 mm, and metastasis to mediastinal and regional lymph nodes was observed. Immunohistochemically, both surface and round cells were positive for epithelial membrane antigen, thyroid transcription factor 1, and vimentin. Only surface cells expressed creatine kinase, carcinoembryonic antigen, napsin A, and cytokeratin 7, and only round cells expressed progesterone receptor. Ki-67 was detected in ~3% of cells, and the rate of weak positive p53 staining was 3%. Both cell types were negative for chromogranin A, synaptophysin, CD3, and CK20. Multiple metastases in a young SP patient are very rare, and potential mechanisms of metastasis may be related to epithelial–mesenchymal transformation.

Imaging diagnosis of 52 cases of sclerosing pneumocytoma / 医学研究生学报

Objective Sclerosing pneumocytoma (SP) is a rare benign tumor of the lung. This study investigates the CT and PET/CT features of 52 patients with sclerosing pneumocytoma (SP), summarizes their imaging features and provide reference for improving the accuracy of SP imaging diagnosis.Methods The clinical and imaging data of 52 patients with SP confirmed by operation and pathology in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine and the First Affiliated Hospital of Nanjing Medical University from January 2010 to March 2018 were analyzed retrospectively，and the imaging features of the disease were analyzed and summarized. Among 52 SP patients, 46 were female and 6 were male, with an average of 50.7±12.6 years old.Results ①Morphological characteristics: all were round or round-shaped solitary nodules or masses in the lung. The average diameter of the tumor was 22.2±15.4 mm. 39 lesions had smooth edges and 13 had shallow edge lobulation sign; ②Predilection sites: 33 of the cases were closely attached to or adjacent to the pleura, and there was no preponderant distribution of the lobe; ③Density: The density of the lesion was homogeneous. 8 cases had coarse calcifications at the edges or in the lesions; ④Enhancement features: 26 cases showed moderate to marked enhancement, only 6 cases were mild enhancement; ⑤Features around the tumor: "vascular adhering sign" in 21 cases, "tail sign" in 7 cases, "air crescent sign " in 5 cases, "localized emphysema" in 4 cases, "halo sign" in 11 cases, "bird egg-bird nest sign" in 5 cases, 4 cases of secondary bronchiectasis; ⑥Associated tumors: 3 cases of invasive lung adenocarcinoma, 3 cases of lung adenocarcinoma in situ, 2 cases of pulmonary atypical adenomatous hyperplasia, 1 case of pulmonary tiny inflammatory nodule; 2 cases of esophageal cancer associated, 1 case of invasive thymoma, 1 case of large mature ovarian cystic teratoma; ⑦PET/CT characteristics: 18F-FDG standard uptake value in tumor increased to different degrees, the average of SUV max value was 4.4±3.2.Conclusion The innovation of this research: SP is shown as solitary circular or circular-shaped blood-rich nodules in the lung, often under the pleura, especially the mediastinal pleura and lobar pleura. There is no lobar distribution advantage; SP calcification is uncommon, among which the calcification at the margin of the tumor was more common. "Air crescent sign", " Halo sign" and " Bird egg-bird nest sign" have high diagnostic value for SP.

Correlative analysis on CT features and pathology of pulmonary sclerosing pneumocytoma / 实用放射学杂志

Objective To analyze the MSCT features of pulmonary sclerosing pneumocytoma (PSP)combined with pathologic findings,to improve understanding of imaging features of PSP.Methods The clinical features of 38 PSP patients confirmed by pathology between 2006 and 2015 were reviewed.All patients underwent MSCT plain and enhanced scan.The imaging findings were studied retrospectively combined with clinical pathology.Results 38 lesions were solitary roundlike nodules and masses.Among which 1 9 lesions were less than 3 cm, 9 lesions were more than 5 cm and 10 lesions were between 3 cm and 5 cm.6 lesions had cystic degeneration,13 lesions had calcification;8 lesions with heterogeneous density showed maplike distribution on unenhanced scans;1 9 lesions were homogeneous enhancement;1 9 lesions maplike heterogeneous enhancement,and 3 of 1 9 had significant peripheral enhancement;35 lesions were progressive enhancement. There were strip-shape vessels in 10 lesions in arterial phase,welt vessel sign in 26 lesions;halo sign in 8 lesions,air-meniscus sign in 3 lesions,pulmonary artery sign in 10 lesions,and tail sign in 9 lesions.There was halo sign with air-meniscus sign in 1 lesion.Conclusion PSP has the general characteristics of benign tumors,and there have certain characteristics in calcification,density distribution,enhancement form and adjoint features.A comprehensive analysis of all the MSCT features combined with clinical pathology can help to improve the accuracy of diagnoses in PSP.

Multiple Sclerosing Pneumocytoma Resected via Minimally Invasive Small Incision, Muscle-and Rib-sparing Thoracotomy: Case Report / 中国微创外科杂志

Sclerosing pneumocytoma is now classified into adenomas of the lung tumor belonging to benign tumors . Multiple sclerosing pneumocytoma is rare .A fifty-nine years old female patient underwent minimally invasive small incision , muscle-and rib-sparing thoracotomy ( miMRST) in August 2012.A lobectomy was made for a 5-cm tumor at the right lower lobe of the lung and a wedge resection was made for another 0.7-cm tumor at the right middle lobe of the lung .Post-operative pathological diagnosis was multiple sclerosing pneumocytoma .No recurrence or metastasis was found after four years ' follow-up.

18F-FDG PET/CT features of pulmonary sclerosing pneumocytoma / 中国医学影像技术

Objective To investigate the characteristics of 18F-FDG PET/CT imaging in pulmonary sclerosis pneumocytoma (PSP).Methods The clinical and PET/CT data of 16 patients with pathologically proved PSP were retrospectively analyzed.The location,shape,size,internal and external edge of the lesion,as well as the metabolism of the lesions were observed.The mean retention index (RI) was calculated in 6 patients with 18F-FDG PET/CT dual phase imaging.The difference of SUVmax between early and delayed phase were compared.And the correlation between the diameter of lesions and SUVmax were analyzed.Results There were 16 lesions in all 16 patients,including 7 cases located at right lung and 9 located at left lung.The lesions were round with the diameter of (1.97-4-0.61)cm.The uniform density were observed with the CT value of (29.87±4.71)HU.And there was no cystic degeneration and necrosis.Calcification was found in 5 lesions.The edge of 14 lesions was smooth,and the edge of another 2 lesions showed short spicular sign.Two lesions showed visible edges of ground glass opacity.There were 12 lesions with vascular welt sign and 3 lesions with air crescent sign.The SUVmax value of PSP was 2.71 ± 2.13.There was no significant difference between the early SUVmax (2.44±1.57) and delayed SUVmax (2.74±1.83) in patients with dual phase imaging (t=2.09,P＞0.05).RI was (7.23±10.29)％.There was no correlation between PSH diameter and SUVmax(r=0.188,P＞0.05).Conclusion Most of PSP showed solitary pulmonary nodules in PET/CT imaging.The radioactive distribution was mild and moderate increase.The vascular welt sign,air crescent sign and the surrounding ground glass opacity are the references findings of PSP.

The comparison of CT features and pathologic changes of pulmonary sclerosing pneumocytoma / 实用放射学杂志

Objective To analyze CT morphologic features and pathologic changes of pulmonary sclerosing pneumocytoma (PSP) and to improve preoperative diagnostic accuracy of PSP.Methods The clinical and CT data of 12 cases with PSP (with total 13 lesions)confirmed by surgery and pathology were collected and analyzed retrospectively.All cases performed CT plain scan,9 cases had contrast CT scan.Results 1 1 cases had isolated lesions,and 1 case multiple lesions.The long-axis diameter ranged from 1.10 cm to 8.03 cm, with an average of (3.53±0.78)cm.Of 13 lesions,3 located in left lung (23.1%,1 in the upper lobes,2 in lower lobe),and 10 in right lung (76.9%,2 in upper lobe,2 in the middle lobe and 6 in lower lobe);8 lesions located in the lower lobe (61.5%),and 5 in upper and middle lobe (38.5%).There were center type of 4 lesions (30.8%),and peripheral type of 9 lesions (69.2%);The shapes of 8 lesions wereovoid or similar round (61.5%),irregular type of 1 case (7.7%),shallow lobe of 4 cases (30.8%);Smooth edge of 10 cases (76.9%), burr edge in 3 cases (23.1%).With contrast CT scan,7 cases (53.8%)had vascular welt sign,6 cases (46.2%)had air crescent sign,6 cases (46.2%)had halo sign,and 6 cases (46.2%)had tail sign.3 lesions (23.1%)had scattered spot calcification,and the other lesions had uniform density.The CT value ranged from 28 HU to 47 HU,with the average of 35 HU;Of 9 cases (with 10 lesions)with contrast CT scan,2 lesions had mild enhancement,5 cases had obvious enhancement,and 3 case had non-uniform enhancement.Enhanced CT value was 60-1 10 HU,with the average of 77.2 HU,and with the maximum of 75 HU.Conclusion If the pulmonary nodules or masses in middle-aged females had single round or ovoid shape,with about 3 cm diameters,soft-tissue density,smooth edge,and with obvious enhancement after contrast CT scan,and accompanied by vascular welt sign,air crescent sign,halo sign,or tail sign, the diagnosis of PSP should be considered.

Caso clínico: hemangioma esclerosante (neumocitoma) pulmonar / Clinical case: lung sclerosing hemangioma (pneumo cytoma)

El objetivo de este artículo es presentar un caso de raro de tumor pulmonar benigno, hemangioma esclerosante (neumocitoma), en una mujer de 24 años, asintomática, con hallazgo radiológico incidental. Se describen las características clínicas, imagenológicos y anátomo-patológicos de la entidad, con una breve revisión bibliográfica.

We present a rare case of benign lung neoplasia, sclerosing hemangioma (pneumocytoma), in a woman 24 years old, asymptomatic, with radiological incidental find. The clinical, imaging and pathological features of the entity are described, with brief bibliographic review.

Case of pulmonary pneumocytoma: A probable cytological diagnosis with histopathological confirmation.

Pneumocytoma is a rare benign tumor of the lung that usually presents as a solitary pulmonary nodule. It is believed to arise from the primitive undifferentiated respiratory epithelium. We report a case of pulmonary pneumocytoma that was suspected on needle aspiration smears and confi rmed histologically. This case describes the cytological features of pneumocytoma that are rarely described in textbooks.