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Kanamoto Y, Dejima H, Saito Y, Haga T, Watanabe T, Yamauchi Y, Sasajima Y, Saito K, Kawamura M, Sakao Y. Solitary pulmonary capillary hemangioma mimicking a preinvasive malignant lesion in an asymptomatic middle-aged female patient. Int Cancer Conf J 2022; 12:14-18. [PMID: 36605833 PMCID: PMC9807707 DOI: 10.1007/s13691-022-00570-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023] Open
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a rare disease characterized by a proliferation of capillaries in the alveolar septa, bronchial and venous walls, pleura, and regional lymph nodes. However, the etiology of the disease remains unknown due to its rarity. Therefore, we present a case of a solitary PCH lesion without symptoms in a 38-year-old female patient. According to computed tomography, she was diagnosed with lung carcinoma, indicated by a tiny nodule with ground-glass opacity detected in her right upper lung. However, no other lesions were detected on systemic examination. Consequently, partial lung resection was conducted, since the lesion was suspected of lung adenocarcinoma. Pathologic results showed that the thick alveolar septa were caused by capillary growth without cellular atypia and hardly any infiltration of inflammatory cells. Finally, we diagnosed the pulmonary lesion as PCH, although solitary PCH has previously been reported in a few case reports. Therefore, further case studies are essential to clarify the causes of PCH.
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Affiliation(s)
- Yasuyuki Kanamoto
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Hitoshi Dejima
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan ,grid.412305.10000 0004 1769 1397Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Yuichi Saito
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Toshihiro Haga
- grid.412305.10000 0004 1769 1397Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Tomohiro Watanabe
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Yoshikane Yamauchi
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Yuko Sasajima
- grid.412305.10000 0004 1769 1397Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Koji Saito
- grid.412305.10000 0004 1769 1397Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Masafumi Kawamura
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
| | - Yukinori Sakao
- grid.264706.10000 0000 9239 9995Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, 186-8606 Japan
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Cortopassi IO, Gosangi B, Asch D, Bader AS, Gange CP, Rubinowitz AN. Diseases of the pulmonary arteries: imaging appearances and pearls. Clin Imaging 2022; 91:111-125. [DOI: 10.1016/j.clinimag.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
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Anazawa R, Terada J, Sakao S, Shigeta A, Tanabe N, Tatsumi K. Features of radiological and physiological findings in pulmonary capillary hemangiomatosis: an updated pooled analysis of confirmed diagnostic cases. Pulm Circ 2019; 9:2045894019896696. [PMID: 31908771 DOI: 10.1177/2045894019896696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022] Open
Abstract
Pulmonary capillary hemangiomatosis (PCH) is a very rare and refractory disease characterized by capillary angioproliferation. The updated classification of pulmonary hypertension categorizes PCH into a subgroup of pulmonary arterial hypertension (PAH) alongside pulmonary veno-occlusive disease (PVOD). However, the definitive diagnosis of PCH only with noninvasive tools remains difficult. The aim of this study was to elucidate the radiological and physiological characteristics of PCH. We searched for cases of pathologically confirmed PCH in the English literature published between 2000 and 2018. We identified 26 cases among 39 studies. Then, we extracted and evaluated the relevant clinical information in all cases with available data. On chest computed tomography (CT), ground-glass opacities (GGOs) were observed in 92% of the cases, in which poorly defined nodular pattern was the most common (88%). GGOs in a bat-wing distribution were observed in one case. Septal lines and lymph node enlargement were observed less frequently (each 19%, 12%). Seven cases (27%) had overlapping abnormalities. Diffusing capacity of the lung for carbon monoxide (DLCO) was remarkably decreased. Alveolar hemorrhage by histological findings or bronchoalveolar lavage (BAL) was observed in seven cases. The present study showed that the most characteristic findings of CT in PCH was centrilobular GGOs with a poorly defined nodular pattern, and septal lines and lymph node enlargement were seen less frequently. Alveolar hemorrhage detected by BAL and decreased DLCO may also be helpful to recognize the possibility of PCH like PVOD.
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Affiliation(s)
- Rie Anazawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Jiro Terada
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Ayako Shigeta
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
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Jaffey JA, Williams KJ, Masseau I, Krueger M, Reinero C. Vasoproliferative process resembling pulmonary capillary hemangiomatosis in a cat. BMC Vet Res 2017; 13:72. [PMID: 28320395 PMCID: PMC5359803 DOI: 10.1186/s12917-017-0984-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary capillary hemangiomatosis is a rare, vascular obstructive disorder that uniformly causes pulmonary arterial hypertension. Clinically, pulmonary capillary hemangiomatosis is indistinguishable from primary pulmonary arterial hypertension and histology is required for definitive diagnosis. The distinctive histologic feature of pulmonary capillary hemangiomatosis is non-malignant extensive proliferation of capillaries in the alveolar septae. Vasodilator treatment of humans with primary arterial hypertension due to pulmonary capillary hemangiomatosis can result in fatal acute pulmonary edema. Computed tomography is thus critical to discern pulmonary capillary hemangiomatosis from other causes of pulmonary arterial hypertension prior to vasodilator therapy. This is the first report of a vasoproliferative process resembling pulmonary capillary hemangiomatosis in the feline species. CASE PRESENTATION A 15-year-old, male castrated, domestic shorthair cat presented for persistent labored breathing presumptively due to congestive heart failure despite treatment with diuretics for 7 days. Echocardiography showed evidence of hypertrophic cardiomyopathy with severe pulmonary hypertension; however, a normal sized left atrium was not consistent with congestive heart failure. Thoracic computed tomography was performed and showed evidence of diffuse ill-defined nodular ground glass opacities, enlarged pulmonary arteries, and filling defects consistent with pulmonary thromboembolism. The cat acutely decompensated after a single dose of sildenafil and was euthanized. Histopathology of the lungs showed severe multifocal alveolar capillary proliferation with respiratory bronchiolar infiltration, marked type II pneumocyte hyperplasia and multifocal pulmonary arterial thrombosis. CONCLUSION This is the first description in a cat of a vasoproliferative disorder resembling pulmonary capillary hemangiomatosis complicated by multifocal pulmonary arterial thrombosis. Inspiratory and expiratory ventilator-driven breath holds with angiography revealed lesions predominantly characterized by ground glass opacification and vascular filling defects with absence of air trapping. The results from this report suggest that, as in humans, the cat can develop a pulmonary capillary hemangiomatosis-like disease in which vasodilator therapy to address pulmonary hypertension may lead to fatal pulmonary edema.
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Affiliation(s)
- J A Jaffey
- University of Missouri Veterinary Health Center, Columbia, MO, USA
| | - K J Williams
- Michigan State University, East Lansing, MI, USA
| | - I Masseau
- Université de Montréal, St-Hyacinthe, Québec, Canada
| | - M Krueger
- Veterinary Specialty Hopsital of Hong Kong, Wan Chai, Hong Kong
| | - C Reinero
- University of Missouri Veterinary Health Center, Columbia, MO, USA.
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Chaisson NF, Dodson MW, Elliott CG. Pulmonary Capillary Hemangiomatosis and Pulmonary Veno-occlusive Disease. Clin Chest Med 2016; 37:523-34. [DOI: 10.1016/j.ccm.2016.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cha MJ, Lee KS, Hwang HS, Kim TJ, Kim TS, Kim BT, Ko YH, Shim YM. Pulmonary Intravascular Lymphomatosis: Clinical, CT, and PET Findings, Correlation of CT and Pathologic Results, and Survival Outcome. Radiology 2016; 280:602-10. [PMID: 26943231 DOI: 10.1148/radiol.2016151706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To describe clinical, computed tomographic (CT), and positron emission tomographic (PET) features, correlation of CT and pathologic results, and survival of patients with pulmonary intravascular lymphomatosis. Materials and Methods The institutional review board approved this retrospective study with waiver of patient consent. Forty-two patients with pulmonary intravascular lymphomatosis were identified, 11 (26%) of whom showed lung involvement. CT features were correlated with histopathologic results. Clinical and survival outcomes were compared between patients with and those without pulmonary involvement by adopting the χ(2), Student t, or Kaplan-Meier analysis with log-rank tests. Results At clinical presentation, all 11 patients showed B symptoms (systemic symptoms of fever, night sweats, and weight loss), 10 had respiratory and four had neurologic symptoms, and two had skin lesions. Patients received cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with (n = 5) or without (n = 6) rituximab, and seven (64%) patients died. Patients with lung involvement showed reduced overall and recurrence-free survival (median; 10.8 and 18.9 months, respectively) compared with those without lung involvement (median, 18.4 and 31.0 months, respectively) (P = .338 and .065, respectively). The most common CT abnormality was bilateral ground-glass opacity (GGO, n = 10), with increased fluorodeoxyglucose uptake at PET/CT (seven of seven patients). GGO correlated histopathologically with the expanded alveolar septal vasculatures and perivascular spaces filled with neoplastic lymphoid cells. Conclusion Pulmonary intravascular lymphomatosis appeared as bilateral GGO on CT images, with increased fluorodeoxyglucose uptake on PET/CT images. GGO on CT images correlated with the area of expanded alveolar septae because of distended vessels filled with neoplastic lymphoid cells. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Min Jae Cha
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Kyung Soo Lee
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Hye Sun Hwang
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Tae Jung Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Tae Sung Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Byung-Tae Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Young-Hyeh Ko
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Young Mog Shim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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7
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Porres-Aguilar M, Al-Bayati I, Porres-Muñoz M, Padilla O, Syed SH, Lowder K, Azimova K, Fan J, Mukherjee D, Abbas A. Pulmonary veno-occlusive disease as a cause of pulmonary arterial hypertension. Proc (Bayl Univ Med Cent) 2015; 28:350-2. [PMID: 26130886 DOI: 10.1080/08998280.2015.11929271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) represents a rare form of precapillary pulmonary arterial hypertension. We present a young patient hospitalized with progressive dyspnea, with initial workup suggestive of pulmonary hypertension and unexplained noncardiogenic pulmonary edema. His subsequent clinical course was consistent with the diagnosis of PVOD.
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Affiliation(s)
- Mateo Porres-Aguilar
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Ihsan Al-Bayati
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Mateo Porres-Muñoz
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Osvaldo Padilla
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Saad H Syed
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Kevin Lowder
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Komola Azimova
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Jerry Fan
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Debabrata Mukherjee
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
| | - Aamer Abbas
- Department of Internal Medicine (Porres-Aguilar, Al-Bayati, Syed), Department of Pathology (Padilla), Division of Cardiovascular Diseases (Mukherjee, Abbas), and medical student (Lowder, Azimova, Fan), Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Texas; and Universidad Autonoma de Tamaulipas School of Medicine and Division of General Internal Medicine, Beneficencia Española de Tampico, Tampico, Mexico (Porres-Muñoz)
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8
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O'Keefe MC, Post MD. Pulmonary capillary hemangiomatosis: a rare cause of pulmonary hypertension. Arch Pathol Lab Med 2015; 139:274-7. [PMID: 25611112 DOI: 10.5858/arpa.2013-0500-rs] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary capillary hemangiomatosis is a rare cause of pulmonary hypertension characterized by extensive proliferation of pulmonary capillaries within alveolar septae. Clinical presentation is nonspecific and includes dyspnea, cough, chest pain, and fatigue. Radiology shows diffuse centrilobular ground-glass opacities. Pulmonary capillary hemangiomatosis is clinically and radiographically indistinguishable from peripheral venoocclusive disease, making microscopic diagnosis essential. Histologically, pulmonary capillary hemangiomatosis shows an abnormal proliferation of small, thin-walled capillaries that expand the alveolar septae. The endothelial cells that comprise these lesions are cytologically bland and show no mitotic activity. Pulmonary capillary hemangiomatosis is important to recognize because prostacyclin therapy, a mainstay in the treatment of pulmonary hypertension, has been reported to cause sudden respiratory distress and death in these patients. Prognosis of this disease remains poor, and the only definitive treatment is lung transplantation.
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Affiliation(s)
- Mary C O'Keefe
- From the Department of Pathology, University of Colorado, Aurora
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9
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Odronic SI, Narula T, Budev M, Farver C. Pulmonary capillary hemangiomatosis associated with connective tissue disease: a report of 4 cases and review of the literature. Ann Diagn Pathol 2015; 19:149-53. [PMID: 25886868 DOI: 10.1016/j.anndiagpath.2015.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 03/16/2015] [Indexed: 11/25/2022]
Abstract
Pulmonary hypertension (PHTN) can be seen in patients with connective tissue disease (CTD). The typical pathology associated with CTD is interstitial fibrosis and hypertensive pulmonary arteriopathy. We describe 4 patients with CTD and PHTN unexpectedly found to have pulmonary capillary hemangiomatosis (PCH) at explant after lung transplantation or autopsy. Pulmonary capillary hemangiomatosis is defined as a proliferation of capillaries in alveolar walls and can clinically cause PHTN. We detail the pathologic findings of PCH, describe the differential diagnosis, and present a review of the literature on the possible association of PCH with CTD. Although PCH may present clinically as PHTN, it is critical to differentiate between the typical CTD-associated interstitial fibrosis with hypertensive pulmonary arteriopathy and PCH because the treatment is different. We provide the largest case series to date and highlight the need for pathologists to have a high level of suspicion for PCH in patients with CTD.
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Affiliation(s)
- Shelley I Odronic
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Tathagat Narula
- Pulmonary, Allergy, and Critical Care, Cleveland Clinic, Cleveland, OH
| | - Marie Budev
- Pulmonary, Allergy, and Critical Care, Cleveland Clinic, Cleveland, OH
| | - Carol Farver
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH.
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10
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Best DH, Sumner KL, Austin ED, Chung WK, Brown LM, Borczuk AC, Rosenzweig EB, Bayrak-Toydemir P, Mao R, Cahill BC, Tazelaar HD, Leslie KO, Hemnes AR, Robbins IM, Elliott CG. EIF2AK4 mutations in pulmonary capillary hemangiomatosis. Chest 2014; 145:231-236. [PMID: 24135949 DOI: 10.1378/chest.13-2366] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Pulmonary capillary hemangiomatosis (PCH) is a rare disease of capillary proliferation of unknown cause and with a high mortality. Families with multiple affected individuals with PCH suggest a heritable cause although the genetic etiology remains unknown. METHODS We used exome sequencing to identify a candidate gene for PCH in a family with two affected brothers. We then screened 11 unrelated patients with familial (n = 1) or sporadic (n = 10) PCH for mutations. RESULTS Using exome sequencing, we identified compound mutations in eukaryotic translation initiation factor 2 α kinase 4 (EIF2AK4) (formerly known as GCN2) in both affected brothers. Both parents and an unaffected sister were heterozygous carriers. In addition, we identified two EIF2AK4 mutations in each of two of 10 unrelated individuals with sporadic PCH. EIF2AK4 belongs to a family of kinases that regulate angiogenesis in response to cellular stress. CONCLUSIONS Mutations in EIF2AK4 are likely to cause autosomal-recessive PCH in familial and some nonfamilial cases.
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Affiliation(s)
- D Hunter Best
- Department of Pathology, The University of Utah, Salt Lake City, UT; ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT
| | - Kelli L Sumner
- ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT
| | - Eric D Austin
- Department of Pathology, The University of Utah, Salt Lake City, UT; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY
| | - Lynette M Brown
- Department of Medicine, School of Medicine, and Pulmonary Division, The University of Utah, Salt Lake City, UT; Department of Medicine, Intermountain Medical Center, Intermountain Healthcare, Murray, UT
| | - Alain C Borczuk
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Erika B Rosenzweig
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY
| | - Pinar Bayrak-Toydemir
- ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT
| | - Rong Mao
- ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT
| | - Barbara C Cahill
- Department of Medicine, The University of Utah, Salt Lake City, UT
| | - Henry D Tazelaar
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Mayo Foundation for Medical Education and Research, Scottsdale, AZ
| | - Kevin O Leslie
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Mayo Foundation for Medical Education and Research, Scottsdale, AZ
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ivan M Robbins
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - C Gregory Elliott
- Department of Medicine, School of Medicine, and Pulmonary Division, The University of Utah, Salt Lake City, UT; Department of Medicine, Intermountain Medical Center, Intermountain Healthcare, Murray, UT.
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11
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Rossi A, Zompatori M, Tchouante Tchouanhou P, Amadori M, Palazzini M, Conficoni E, Galiè N, Poletti V, Gavelli G. Rare causes of pulmonary hypertension: spectrum of radiological findings and review of the literature. Radiol Med 2013; 119:41-53. [PMID: 24234182 DOI: 10.1007/s11547-013-0305-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 10/11/2012] [Indexed: 01/30/2023]
Abstract
Following a brief introduction covering the clinical signs and symptoms of pulmonary hypertension (PH), its most recent classification into six groups, and the computed tomography (CT) features common to all forms of PH, this paper illustrates the typical patterns that can be found on chest radiography and CT in rare causes of PH. We present and compare with the existing literature our personal series of cases of rare forms of PH, found in the following diseases: veno-occlusive disease, pulmonary capillary haemangiomatosis, non-thrombotic pulmonary embolism (tumour embolism and carcinomatous lymphangitis, talcosis, hydatid disease), pulmonary artery sarcoma, neurofibromatosis, sarcoidosis, and Langerhans cell histiocytosis. Rare forms of PH show low incidence and prevalence, and are, therefore, poorly recognised. Their diagnosis is a challenge for clinicians, pathologists, and radiologists, and any additional knowledge about the CT findings may help the diagnosis in the case of patients affected by PH of unknown origin.
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Affiliation(s)
- Alice Rossi
- I.R.C.C.S Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), via P. Maroncelli 40/42, Meldola, FC, Italy
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Different sizes of centrilobular ground-glass opacities in chest high-resolution computed tomography of patients with pulmonary veno-occlusive disease and patients with pulmonary capillary hemangiomatosis. Cardiovasc Pathol 2013; 22:287-93. [DOI: 10.1016/j.carpath.2012.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/07/2012] [Accepted: 12/05/2012] [Indexed: 11/21/2022] Open
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13
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Familial pulmonary capillary hemangiomatosis early in life. Case Rep Pulmonol 2011; 2011:827591. [PMID: 22937432 PMCID: PMC3420428 DOI: 10.1155/2011/827591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 10/03/2011] [Indexed: 11/20/2022] Open
Abstract
Background. Pulmonary capillary hemangiomatosis (PCH) is a rare disease, especially in infancy. Four infants have been reported up to the age of 12 months. So far, no familial patients are observed at this age. Patients. We report three siblings, two female newborns and a foetus of 15-week gestation of unrelated, healthy parents suffering from histologically proven PCH. The first girl presented with increased O2 requirements shortly after birth and patent ductus arteriosus (PDA). She subsequently developed progressive respiratory failure and pulmonary hypertension and died at the age of five months. The second girl presented with clinical signs of bronchial obstruction at the age of three months. The work-up showed a PDA—which was surgically closed—pulmonary hypertension, and bronchial wall instability with stenosis of the left main bronchus. Transient oxygen therapy was required with viral infections. The girl is now six years old and clinically stable without additional O2 requirements. Failure to thrive during infancy and a somewhat delayed development may be the consequence of the disease itself but also could be attributed to repeated episodes of respiratory failure and a long-term systemic steroid therapy. The third pregnancy ended as spontaneous abortion. The foetus showed histological signs of PCH. Conclusion. Despite the differences in clinical course, the trias of PCH, PDA, and pulmonary hypertension in the two life born girls suggests a genetic background.
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Okajima Y, Ohno Y, Washko GR, Hatabu H. Assessment of pulmonary hypertension what CT and MRI can provide. Acad Radiol 2011; 18:437-53. [PMID: 21377593 DOI: 10.1016/j.acra.2011.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/06/2011] [Accepted: 01/12/2011] [Indexed: 01/06/2023]
Abstract
RATIONALES AND OBJECTIVES Pulmonary hypertension (PH) is a life-threatening condition, characterized by elevated pulmonary arterial pressure, which is confirmed based on invasive right heart catheterization (RHC). Noninvasive examinations may support diagnosis of PH before proceeding to RHC and play an important role in management and treatment of the disease. Although echocardiography is considered a standard tool in diagnosis, recent advances have made computed tomography (CT) and magnetic resonance (MR) imaging promising tools, which may provide morphologic and functional information. In this article, we review image-based assessment of PH with a focus on CT and MR imaging. CONCLUSIONS CT may provide useful morphologic information for depicting PH and seeking for underlying diseases. With the accumulated technological advancement, CT and MRI may provide practical tools for not only morphologic but also functional assessment of patients with PH.
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Affiliation(s)
- Yuka Okajima
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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15
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Rhee CK, Yim NY, Shim S, Kim HJ. A Case of Pulmonary Capillary Hemangiomatosis-Like Lesion Followed for Seven Years. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.3.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Nam Yeol Yim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Soyeon Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | - Hui Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
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16
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In search of markers of treatment failure and poor prognosis in IPAH - the value of mosaic lung attenuation pattern on thin-section CT scans. Multidiscip Respir Med 2010; 5:409-16. [PMID: 22958311 PMCID: PMC3463058 DOI: 10.1186/2049-6958-5-6-409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 04/30/2010] [Indexed: 11/10/2022] Open
Abstract
Despite the development of specific therapies for pulmonary arterial hypertension (PAH) some patients fail to respond to such treatment. One of the potential reasons for the unresponsiveness to targeted therapies may be the presence of fibrous occlusion of small pulmonary veins that accompanies pre-capillary arteriopathy. This type of pathologic change is called pulmonary veno-occlusive disease (PVOD). Underdiagnosed PVOD occurs probably in 5-10% of idiopathic pulmonary hypertension (IPAH) and in a substantial proportion of PAH related to connective tissue diseases (mainly in scleroderma). A definite diagnosis of PVOD requires histological examination of lung sample, but surgical lung biopsy in pulmonary hypertension is combined with high risk of bleeding. Thus major interest is focused on a non-invasive diagnostic approach enabling early recognition of PVOD and referral for lung transplantation. The present review is focused on the radiological features suggestive of PVOD-like vasculopathy in PAH.
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Kadowaki T, Yano S, Kobayashi K, Araki K, Tokushima T, Yamadori I. Pulmonary capillary hemangiomatosis-like foci detected by high resolution computed tomography. Intern Med 2010; 49:175-8. [PMID: 20075585 DOI: 10.2169/internalmedicine.49.2739] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of pulmonary capillary hemangiomatosis-like foci (PCH-like foci), presenting as multiple ground-glass opacities (GGOs) on high resolution computed tomography (HRCT). The patient underwent a left lingual segmentectomy to make a definite diagnosis of these GGOs on chest CT. Histological findings were similar to PCH; however, there were no clinical symptoms or findings of pulmonary hypertension. Accordingly, PCH-like foci was diagnosed.
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Affiliation(s)
- Toru Kadowaki
- Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, Matsue.
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18
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Ivy DD, Feinstein JA, Humpl T, Rosenzweig EB. Non-congenital heart disease associated pediatric pulmonary arterial hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2009; 27:13-23. [PMID: 21852894 DOI: 10.1016/j.ppedcard.2009.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recognition of causes of pulmonary hypertension other than congenital heart disease is increasing in children. Diagnosis and treatment of any underlying cause of pulmonary hypertension is crucial for optimal management of pulmonary hypertension. This article discusses the available knowledge regarding several disorders associated with pulmonary hypertension in children: idiopathic pulmonary arterial hypertension (IPAH), pulmonary capillary hemangiomatosis, pulmonary veno-occlusive disease, hemoglobinopathies, hepatopulmonary syndrome, portopulmonary hypertension and HIV. Three classes of drugs have been extensively studied for the treatment of IPAH in adults: prostanoids (epoprostenol, treprostinil, iloprost, beraprost), endothelin receptor antagonists (bosentan, sitaxsentan, ambrisentan), and phosphodiesterase inhibitors (Sildenafil, tadalafil). These medications have been used in treatment of children with pulmonary arterial hypertension, although randomized clinical trial data is lacking. As pulmonary vasodilator therapy in certain diseases may be associated with adverse outcomes, further study of these medications is needed before widespread use is encouraged.
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Affiliation(s)
- D D Ivy
- University of Colorado Denver School of Medicine and The Children's Hospital, United States
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Asai Y, Miyao N, Nakagawa M, Abe S, Inagaki Y, Suzuki O, Mizuno Y, Shimizu K. [Pulmonary capillary hemangiomatosis: report of an autopsy case and review of the literature]. ACTA ACUST UNITED AC 2008; 97:2788-90. [PMID: 19069124 DOI: 10.2169/naika.97.2788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yoshihito Asai
- The Department of Internal Medicine, Nihon Koukan Hospital, Kanagawa
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