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Fan X, Lin L, Wang J, Wang Y, Feng A, Nie L, Wu H, Meng F, Xu H. Genome profile in a extremely rare case of pulmonary sclerosing pneumocytoma presenting with diffusely-scattered nodules in the right lung. Cancer Biol Ther 2017; 19:13-19. [PMID: 29236566 DOI: 10.1080/15384047.2017.1360443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pulmonary sclerosing pneumocytoma (PSP) typically presents solitary and peripheral mass, while only rarely cases display unusual multiple lesions. We reported a extremely rare case of PSP with diffusely-scattered nodules in the right lung. CASE PRESENTATION Diffusely round-shaped nodular shadows in the right lung were found by CT scan in a 31-year-old Chinese woman. The patient undergone the right pneumnectomy. Grossly, numerous small nodules, up to 2.5 cm in greatest dimension were identified in the upper, middle and lower lobes of the right lung. Histologically, the tumor presented the typical features of PSP, with a variable proportion of solid, sclerotic and papillary patterns. Immunohistochemical staining further revealed that cuboidal surface epithelial cells were positive for TTF-1, EMA, AE1/3 and vimentin (partially), and round or polygonal cells expressed TTF-1, vimentin, EMA (weakly), synaptophysin (partially), progesterone receptor (partially), and estrogen receptor (scatteredly). The patient has been followed up for 83 months after surgery by annual chest CT and no new lesions are detected in her left lung and other organs. The whole-exome sequencing identified 15 somatic mutations genes (MEGF6, DNAH5, AKT1, GPRIN2, PIK3AP1, FBXO40, HERC1, VPS16, MORN1, ZNF474, CTNNB1, ZNF251, TSC1, ATM, KDR). Pathway analysis showed possible pathways like the components of CTNNB1, AKT1, and TSC1 mutations in the PI3K/AKT signalings and AKT1, KDR and ATM in VEGF signaling pathway and AKT1 activation seemed closely related with these pathways. CONCLUSION According to our and previous data, PSP with diffuse or multiple lesions is very rare, and the patients are most commonly seen in women in Asian countries. The misdiagnosis rate by clinical and intraoperative frozen-section assessment is high because of the multiple nodules in the lung and its confusing histological features. Long time follow up indicates surgical resection should not be considered as the preferred strategy for treating multiple PSP in the intralobar sites. AKT1 activation may contribute to the development of PSP while the pathogenesis of diffuse or multiple PSP still needs to be further analyzed.
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Affiliation(s)
- Xiangshan Fan
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Ling Lin
- b Department of Medicine , Shanghai Biotecan Pharmaceuticals Co., Ltd. , Pudong New District , Shanghai , China
| | - Jianjun Wang
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Yu Wang
- b Department of Medicine , Shanghai Biotecan Pharmaceuticals Co., Ltd. , Pudong New District , Shanghai , China
| | - Anning Feng
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Ling Nie
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Hongyan Wu
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Fanqing Meng
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Haodong Xu
- c Department of Pathology & Laboratory Medicine , David Geffen School of Medicine, UCLA , Los Angeles , California , USA
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