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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.
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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.
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No abstract available.
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Aged , Female , Humans , Biomarkers, Tumor/analysis , Biopsy, Large-Core Needle , Bone Neoplasms/chemistry , Immunohistochemistry , Lung Neoplasms/chemistry , Pneumonectomy , Positron-Emission Tomography , Pulmonary Sclerosing Hemangioma/chemistry , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Sclerosing pneumocytoma (SP) of the lung is a rare benign neoplasm. Here, we describe an unusual presentation of SP with a wax-and-wane pattern of growth in a 47-year-old woman. Tumor diameter decreased over a 3-year follow-up period and then increased on serial follow-up computed tomography scans. The mass showed high signal intensity on both T1- and T2-weighted chest magnetic resonance imaging (MRI) and early enhancement with a plateau on dynamic MRI. We speculate that intratumoral bleeding and resorption processes accounted for the changes in tumor size.
Subject(s)
Female , Humans , Middle Aged , Lung/pathology , Magnetic Resonance Imaging/methods , Pulmonary Sclerosing Hemangioma/diagnosis , Tomography, X-Ray Computed/methodsABSTRACT
Objective To evaluate characteristics of CT and 18F-FDG PET/CT in pulmonary sclerosing hemangioma (PSH).Methods A retrospective study involving 12 patients (2 males,10 females;24-80 years old) confirmed as PSH by pathology from May 2012 to July 2014 was investigated.All patients underwent chest CT scan,including enhanced CT;and 5 cases underwent whole-body 18F-FDG PET/CT.All imaging data were collected and analyzed to find out a more effective diagnostic method.Results In 12 PSH patients,9 had single lesion,of which 4 involved left lung and 5 right lung.The rest 3 patients including 1 with two nodules located in the right lower lobe,and 2 with multiple nodules scattered in several lobes.Plain CT showed all lesions had uniformly isodensity,4 with calcification,3 with air meniscus sign.Contrast-enhanced CT examinations showed that the majority lesions were prominent enhancement and few moderate enhancement,all lesions showed vessel marginating sign and 6 with cystic and necrosis area.18F-FDG PET/CT examinations showed that the lesions displayed patchy pattern of mild to moderate uptake with SUVmax 2.2--4.0.Conclusions The characteristic CT features of PSH,especially the contrast-enhanced CT imaging,are important for diagnosis.18F-FDG PET/CT findings are extremely helpful in differentiating PSH from malignant lesions.
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Purpose To analyze retrospectively the clinicopahological characteristics and immuophenotype in 120 cases of pulmonary selerosing hemangioma ( PSH) . Methods Data of 120 cases of PSH were collected and reviewed, including gross features and frozen diagnosis, histopathological features, morphology in HE and immunohistochemical characteristics of tumor cells. Results PSH pres-ents a well-circumscribed mass with a sense of expansion after cutting, which showed a solid, grey to tan-yellow surface with foci of haemorrhage. Two kinds of tumor cells and four typical patterns with mixed forms, are often shown under light microscope (92/120, 76. 67%). Focal accumulation of histocytes and scattered mast cells were noted in some cases (83/120, 69. 17%). Both surface cells and round cells were TTF-1 and EMA positive. Surface cells expressed SP-A, CK and NapsinA. Round cells expressed vimentin. Conclusion Gross features and typical“two cell types, four patterns” contribute to PSH diagnosis. Meanwhile, foal accumulation of foam histocytes and scattered mast cells show a clue to PSH diagnosis and differential diagnosis.
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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.
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Pulmonary sclerosing hemangioma is a relatively rare neoplasm of the lung with polymorphic histologic features of 2 unifying cellular components including surface cuboidal cells and interstitial round cells. Pulmonary sclerosing hemangioma typically occurs in middle aged women with asymptomatic, peripheral, solitary, well-circumscribed lesions. Although it is pathologically benign, it reveals size growing and chest symptom. We here report a case of pulmonary sclerosing hemangioma in a 72-year-old woman. She presented chest discomfort. A chest radiography and a chest computed tomography scan showed growing size from 3.2x3.1 cm to 6.0x5.3 cm in left upper lung during 10 years' follow-up period. Surgical resection of lung revealed a distinct constellation of findings including 2 epithelial cell types, surface cells, and round cells, which form 4 architectural patterns, papillary, sclerotic, solid, and hemorrhagic. She was diagnosed as pulmonary sclerosing hemangioma and chest discomfort disappeared.
Subject(s)
Aged , Female , Humans , Middle Aged , Epithelial Cells , Follow-Up Studies , Lung , Lung Diseases , Pulmonary Sclerosing Hemangioma , ThoraxABSTRACT
ObjectiveTo study the expressions of Ki-67 and p53 in the surface cells and polygonal cells in pulmonary sclerosing hemangioma(PSH)and investigate the relation of cell proliferation index and biological behaviour of the tumor.MethodsDouble-staining immunohistochemistry was used to detect the expressions of Ki-67 and CK8/18 protein. Double immunofluorescence staining was used to detect the expressions of p53 and AE1/AE3 protein. ResultsThe positive signal of AE1/AE3 and CK8/18 were localized in cytomembrane of surface cells. The positive signal of Ki-67 and p53 were localized in cell nucleus of the two kinds of cells.The positive rate of Ki-67 was under 1％ in surface cells and 1％-10 ％ in polygonal cells. p53 protein was mainly expressed in polygonal cells (6/9, 33.3 ％) and only exsited in seldom surface cells.ConclusionThere are differences on cellular morphous and immunophenotype between the surface cells and polygonal cells.The proliferation index and gene mutation are all predominant in polygonal cells than in surface cells. The biological behaviour of PSH maybe mainly be decided by the polygonal cells.
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Objective To investigate the diagnosis and therapy of the sclerosing hemangioma of the lung.Mothods The case history of 15 patients were analyzed retrospectively and summarized the diagnosis and therapy of the Sclerosing hemangioma of the lung.Results There were 2 males and 13 females(1:6.5).No patients were diagnosed this disease before operation for there were no specific imageology features.The tumor cell indicated pantomorphia and there were 3 cases were misdiagnosed during the operation frozen section pathology.The optimization therapy methods was to resect the tumor with the VATS.The prognosis of this disease was well and there were no cases recurrence in these 15 patients.Conclusion The sclerosing hemangioma of the lung was the benign tumor and there were no specific imageology features.The misdiagnosis was frequently before operation.To resect the tumor with the VATS was the optimal therapy method.
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Objective To investigate the unusual CT features of pulmonary sclerosing hemangioma (SH). Methods Clinical and CT features of 25 patients of pulmonary SH proved with pathology were reviewed, among which 15 patients underwent plain and enhanced CT scan, 10 underwent only plain CT scan. Results Solitary nodules (20/25, 80.00%) and solitary mass (5/25, 20.00%) were found with CT. CT features included slight lobulation (6/25, 24.00%), calcification (6/25, 24.00%), ground glass opacity (2/25, 8.00%), emphysema (1/25, 4.00%), endobrochial variant (1/25, 4.00%), short speculation (1/25, 4.00%) and vascular bundle (2/25, 8.00%). Slight or remarkable enhancement was noticed in all 15 patients underwent contrast enhanced CT. Conclusion CT can reveal features and unusual manifestations of pulmonary SH, and is helpful to the diagnosis of pulmonary SH.
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A case of sclerosing hemangioma of the lung is reported in a young male, who presented with recurrent cough and streaky hemoptysis for three years. The tumor was situated in the right upper lobe and was large (over 9 cm), multicentric and associated with metastases to the regional lymph nodes. To the best of our knowledge, only 14 cases with such metastases have been reported.
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Objective To investigate the clinical and pathologic features of pulmonary sclerosing he- mangioma (PSH).Methods With clinicopathologic date of 21 cases of PSH patients obtained,all speci- mens were stained by immunohistochemical method with a panel of antibodies including CK,synaptophysin, chromogranin,actin,calretinin,F-Ⅷ,CD_(34) and vimentin.Results PSH usually affects female patients.Age ranged from 26 to 70 years old.The tumor cells showed a mixture histological pattern,with the feature of pap- illary and the proliferation of interstitutial monocyte.Immunohistochemical staining revealed that surface of the papillary cells expressed CK,monocyte expressed synaptophysin.PSH should be distinguished from bronchi- oloalveolar carcinoma,carcinoid and inflammatory pseudotumor.Conclusion PSH is a rare and potential malignant behavior tumor,and is different from benign tumor.
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A 42 years old woman underwent F-18 FDG PET because of the incidentally detected lung mass on chest X-ray. PET/CT showed hypermetabolic lesion in the lung right upper lobe and the lung cancer was suspected because of the high FDG uptake. However, pathologic diagnosis was sclerosing hemangioma. There are few reports on the evaluation of sclerosing hemangioma using FDG PET. A report showed a slightly increased uptake (standardized uptake ratio of 1.8) (1), and another report showed unsatisfactory result (2). We suggest that sclerosing hemangioma could be seen as hypermetabolic lesion on the FDG PET.
Subject(s)
Adult , Female , Humans , Diagnosis , Histiocytoma, Benign Fibrous , Lung , Lung Neoplasms , Positron Emission Tomography Computed Tomography , ThoraxABSTRACT
Objective To discuss the diagnosis and surgical management of pulmonary sclerosing hemangioma(PSH).Methods Clinical records of 33 cases of PSH(34 lesions) in this hospital from 1987 to 2002 were reviewed.There were 6 male cases and 27 female cases,with a mean age of 41.3 years(range,24~57 years).Twenty-three cases had an initial symptom of bloody sputum,while 10 cases were disclosed by physical examinations.Image findings revealed solitary mass of the lung in all the cases,in 5 of which a "crescent sign" was presented.Results Preoperatively,28 cases were diagnosed as having pulmonary benign tumors(including 5 cases of suspected sclerosing hemangioma),1 case was clarified as having PSH by percutaneous needle aspiration cytology,and 4 cases were misdiagnosed as having lung cancer. All the patients received surgical treatment,including 21 cases of unilateral pulmonary lobectomy,1 case of bilateral lobectomy,5 cases of segmentectomy,4 cases of wedge resection(including 1 case of bilateral thoracoscopic wedge resection),and 2 cases of tumor excision.The operation time was 45~210 min(mean,90 min),and the blood loss was 100~600 ml(mean,230 ml).No peri-operative deaths were encountered.Follow-up surveys in 33 cases for(3~)10 years(mean,5.5 years) found no recurrence.Conclusions In middle-aged women,if the sign of bloody sputum develops,and image findings indicate the solitary mass of the lung,especially with a "crescent sign",a diagnosis of PSH is possible.Percutaneous needle aspiration cytology is helpful to make a confirmative diagnosis in some patients.It is advisable to manage the disease surgically.
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Fine needle aspiration (FNA) cytological examination is an appropriate method for the evaluation of pulmonary nodules. In major types of lung cancer, its diagnostic accuracy is quite high. However, it is sometimes difficult, using this technique, to differentiate between some unusual phenotypes including adenosquamous carcinoma, bronchioloalveolar carcinoma (BAC), neuroendocrine tumor, mucoepidermoid carcinoma, and sclerosing hemangioma. Here, we present a case involving extremely well differentiated adenosquamous carcinoma, mimicking benign lesions, such as pulmonary scar and adenomatoid malformation with squamous metaplasia. The patient was a 68-year-old man presenting with a solitary pulmonary nodule (1.6x1.6 cm), which was incidentally found at the periphery of the right lower lobe. FNA revealed some clusters of glandular cells with minimal atypia, in addition to squamous cells at a nearly full maturational state. Histological examination verified the cytological diagnosis on a lobectomy specimen. The tumor exhibited a well differentiated adenocarcinoma component, mimicking the bronchioles in scarred lung tissue, and a well differentiated squamous cell carcinoma component, mimicking the squamous cell nests of adenoacanthoma, in the other organs. In the present case, the possibility of adenosquamous carcinoma should have been considered if squamous cells were seen in the FNA from the peripheral pulmonary nodule, even though they appeared to be benign.
Subject(s)
Aged , Humans , Adenocarcinoma , Adenocarcinoma, Bronchiolo-Alveolar , Biopsy, Fine-Needle , Bronchioles , Carcinoma, Adenosquamous , Carcinoma, Mucoepidermoid , Carcinoma, Squamous Cell , Cicatrix , Diagnosis , Histiocytoma, Benign Fibrous , Lung Neoplasms , Lung , Metaplasia , Neuroendocrine Tumors , Phenotype , Solitary Pulmonary NoduleABSTRACT
Sclerosing hemangiomas (SH) of the lung are uncommon tumors and are thought to be benign. However, the biologic behavior of this tumor has not yet been characterized adequately. The clinicopathologic features were reviewed and analyzed for 16 cases of SH. The age of the patients ranged from 37 to 73 yr (mean 50.6 yr). There were fifteen female and one male patient. The SH located at the intraparenchyme in 14 cases, the interlobar fissure in one case and the visceral pleura in one case. The size of SH ranged from 0.3 cm to 8 cm (mean 2.6 cm). There were five unusual presentations of SH including a case having two SH with multiple nodules of atypical adenomatous hyperplasia in the same lobe, a case showing adenocarcinomalike area within the SH, a case showing one peribronchial lymph node metastasis (N1 nodal stage) with location of interlobar major fissure, a case showing alveolar adenoma-like area within the SH, and one case with a large visceral pleural-based pedunculated mass presenting as mediastinal mass. All patients were alive and well without recurrence at the last follow up. Here, we reviewed previously published literatures and discussed the histogenesis of SH.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Histiocytoma, Benign Fibrous/diagnosis , Hemangioma/diagnosis , Hyperplasia , Immunohistochemistry , Lung/pathology , Lung Neoplasms/diagnosis , Lymphatic Metastasis , Neoplasm MetastasisABSTRACT
A sixty-eight year old female patient was transferred to our department for the resection of a solitary pulmonary nodule on the right lower lobe. An intraoperative frozen-section revealed a bronchioloalveolar carcinoma. Therefore, a right lower lobectomy and mediastinal lymph node dissection were performed. The permanent pathologic diagnosis of this patient was a sclerosing hemangioma. Herein, our experience of the treatment of a sclerosing hemagioma presenting with a solitary pulmonary nodule by a lobectomy is reported with a review of the literature
Subject(s)
Female , Humans , Adenocarcinoma, Bronchiolo-Alveolar , Diagnosis , Histiocytoma, Benign Fibrous , Lymph Node Excision , Solitary Pulmonary NoduleABSTRACT
Sclerosing hemangioma (SH) of the lung is an uncommon type of tumor, which is composed of polygonal and cuboidal cells. This disease is generally regarded as benign but extremely rare cases with lymph node metastasis have been reported. We report a case of SH with a metastasis to the regional lymph nodes. A 19-year-old girl presented with a 2-year history of coughing. A chest X-ray and a CT scan indicated a large mass in the lower lobe. As a result, a left lower lobectomy with a dissection of the hilar and interlobar lymph nodes was performed. The tumor was a well-defined huge mass with partial adhesion to the mediastinal and parietal pleura. The dissected hilar, interlobar, and intrapulmonary lymph nodes demonstrated metastasis. Histologically, the primary and metastatic tumor consisted of polygonal and cuboidal cells. Both types of tumor cells were uniformly immunoreactive to the epithelial membrane antigen (EMA) and the thyroid transcription factor-1 (TTF-1). However, the cuboidal cells tested positive for pancytokeratin, whereas the polygonal cells tested consistently negative. Postoperatively, the patient received chemotherapy and no recurrence or metastasis 2 years after surgery was noted. Although a pulmonary SH is considered to be benign, this case highlights the need for the evaluation of lymph node metastasis.
Subject(s)
Adult , Female , Humans , Hemangioma/pathology , Lung Neoplasms/pathology , Lymphatic Metastasis , SclerosisABSTRACT
Objective To analyze the imaging characteristics of pulmonary sclerosing hemangioma(PSH) and to improve the accurate rate of its diagnosis before surgery.Methods Imaging findings in 11 cases pathologically proved sclerosing hemangiomas were retrospectively analyzed in comparison with pathology.Results The imaging findings of PSH mostly were solitary masses with homogeneous density,and with smooth margin in 10 cases and irregular margin in 1 case;1 case with slight calcification and 1 case with air-meniscus sign were found.7 cases were homogeneous enhancement and 4 were heterogeneous enhancement on contrast-enhanced scan.The high and low attenuation areas on CT corresponded with angiomatous and cystic areas respecitvely on pathology.Conclusion Chest roentgenogram and unenhanced CT scan of PSH are not of remarkable characteristics,contrast-enhanced CT scan plays an important role in diagnosis and differential diagnosis of PSH.