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Saripalli KR, Wang MQW, Chow CY, Chew SY. Pulmonary sclerosing pneumocytoma - approaching a solitary pulmonary nodule and the limitations of risk prediction models. BMJ Case Rep 2023; 16:e257208. [PMID: 37977835 PMCID: PMC10660428 DOI: 10.1136/bcr-2023-257208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Our case is an asymptomatic, non-smoking, East Asian woman in her 40s presenting with a solitary pulmonary nodule (SPN). On imaging, the 1.7 cm solid SPN located in the left upper lobe, was rounded in morphology and moderately fluorodeoxyglucose avid. The clinical pretest probability of malignancy assessed by risk prediction models such as Brock (19.1%), Mayo Clinic (56.2%) and Herder (51.4%) was discordant. She underwent a percutaneous CT-guided needle biopsy, establishing a diagnosis of pulmonary sclerosing pneumocytoma (PSP). PSP is a rare benign lung neoplasm with indolent growth characteristics that has been described predominantly in non-smoking women. Our case illustrates the limitations of applying existing risk prediction models in Asia where the epidemiology and biology of lung cancer differ significantly from the Caucasian derivation cohorts. Additionally, the risk models do not account for tuberculosis, which is endemic in Asia and can mimic malignancy. Non-surgical lung biopsy remains useful in minimising unnecessary thoracotomy.
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Affiliation(s)
| | - Mark Qi Wei Wang
- Department of Vascular and Interventional Radiology, SingHealth Group, Singapore
| | - Chun Yuen Chow
- Department of Anatomical Pathology, SingHealth Group, Singapore
| | - Si Yuan Chew
- Department of Respiratory and Critical Care Medicine, SingHealth Group, Singapore
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Kim SJ, Kang HR, Lee CG, Choi SH, Kim YW, Lee HW, Lee CH. Pulmonary sclerosing pneumocytoma and mortality risk. BMC Pulm Med 2022; 22:404. [DOI: 10.1186/s12890-022-02199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Surgical resection is usually recommended for the treatment of pulmonary sclerosing pneumocytoma (PSP). However, no comparative study has demonstrated that surgical resection leads to improved outcomes. We aimed to compare all-cause mortality between patients with PSP who underwent surgery or did not and those without PSP.
Methods
Participants aged ≥18 years who had pathologically diagnosed PSP between 2001 to 2018, at 3 hospitals were included. Randomly selected (up to 1:5) age-, sex-, and smoking status-matched controls without PSP who were randomly selected from those who underwent health checkups including chest CT were included. Mortality was compared using Kaplan–Meier estimates and Cox proportional hazards regression models. Literature review of studies reporting PSP was also conducted.
Results
This study included 107 patients with PSP (surgery:non-surgery, 80:27) and 520 matched controls. There were no cases of lymph node or distant metastasis, recurrence, or mortality from PSP. No significant difference in all-cause mortality risk was observed between the PSP surgery, PSP non-surgery, and non-PSP groups (log rank test P = 0.78) (PSP surgery vs. non-PSP: adjusted hazards ratio [aHR], 1.80; 95% confidence interval [CI], 0.22–14.6; PSP non-surgery vs. non-PSP: aHR, 0.77; 95% CI, 0.15–3.86; PSP surgery vs. PSP non-surgery: aHR, 2.35; 95% CI, 0.20–28.2). In the literature review, we identified 3469 patients with PSP from 355 studies. Only 1.33% of these patients reported metastasis, recurrence, or death.
Conclusions
All-cause mortality did not differ between patients with PSP and those without, irrespective of undergoing surgery. Our study and the literature review suggest that PSP has less impact on increased mortality risk.
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Muto Y, Kuse N, Inomata M, Awano N, Tone M, Minami J, Takada K, Fujimoto K, Wada A, Nakao K, Furuhata Y, Hori C, Bae Y, Kumasaka T, Izumo T. A case of pulmonary sclerosing pneumocytoma diagnosed preoperatively using transbronchial cryobiopsy. Respir Med Case Rep 2021; 34:101494. [PMID: 34430194 PMCID: PMC8365508 DOI: 10.1016/j.rmcr.2021.101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/05/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background The preoperative diagnosis of pulmonary sclerosing pneumocytoma (PSP) is complicated since PSP has several histological structural patterns in the same neoplasm; hence, it is sometimes pathologically misdiagnosed as adenocarcinoma or carcinoid. In recent years, with the prevalence of transbronchial cryobiopsy (TBLC), we are able to obtain larger specimens than previously. However, to date, there have been no reports describing PSP diagnosed using TBLC. Case reports A 43-year-old man was referred to our hospital for an abnormal lesion in the left lung discovered on routine health examination. A computed tomography scan of the chest revealed a 14-mm heterogeneous round nodule with surrounding ground-glass opacity in the left lower lobe. The tumor size increased to 18 mm in three weeks, and he developed bloody sputum. TBLC was performed using radial endobronchial ultrasonography and fluoroscopy. An occlusion balloon and prophylactic epinephrine were used to prevent severe bleeding. Histologically, epithelioid cells with solid proliferation, various papillary lesions, and hemosiderin-laden histiocytes were observed. Immunohistochemical staining revealed the histiocytes positive for thyroid transcription factor-1 and vimentin, and the type II pneumocyte-like-cells positive for cytokeratin 7. The tumor was preoperatively diagnosed as a PSP; the patient underwent left basal segmentectomy and consequently, a final diagnosed of PSP was formulated. Conclusion We report the first case of PSP preoperatively diagnosed using TBLC. Therefore, cryobiopsy could be beneficial in the preoperative diagnosis of PSP.
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Affiliation(s)
- Yutaka Muto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Jonsu Minami
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Kohei Takada
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Kazushi Fujimoto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Ami Wada
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Keita Nakao
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Yoshiaki Furuhata
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Chisa Hori
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Yuan Bae
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
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Liu H, Dang H, Wang R, Yao S, Wu Y, Xu B. Analysis of the F-18 FDG PET/CT features of pulmonary sclerosing pneumocytoma. Nucl Med Commun 2021; 42:665-671. [PMID: 33660695 DOI: 10.1097/mnm.0000000000001374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This retrospective study aimed to analyzed the F-18 fluorodeoxyglucose PET/computed tomography (F-18 FDG PET/CT) features of pulmonary sclerosing pneumocytoma (PSP) to improve the understanding and preoperative diagnostic efficacy of this rare disorder. METHODS FDG PET/CT images from 11 patients with 22 lesions (including one patient with 12 lesions) proven PSP in our hospital were reviewed. We summarized the PET/CT features of PSP and analyzed the correlation between FDG uptake and tumor size. RESULTS PET/CT imaging revealed all tumors located in each lobe of the two lungs randomly. All 22 tumors were round or oval nodules; 15 had smooth margins, six were lobulated, six were calcified, and one had a ground-glass halo sign. The mean diameter of these tumors was 19.2 ± 7.8 mm (range: 8-34 mm); the mean maximum standardized uptake value (SUVmax) was 2.8 ± 1.3 (range: 1.1-7.4). Sixteen of the lesions exhibited mild to moderate FDG uptake (mean SUVmax 2.3 ± 0.6), and six of the lesions exhibited intense FDG uptake (mean SUVmax 4.3 ± 1.6). A positive correlation was observed between FDG uptake and tumor size (P <0.05). CONCLUSION Single round or ovoid soft-tissue lesions with smooth margins, and mild to moderate FDG uptake on PET/CT images in middle-aged females, suggest a possible diagnosis of PSP. For some atypical cases with intense FDG uptake, a diagnosis of PSP also can be considered. A statistically significant positive correlation was found between SUVmax and PSP lesion size in our study.
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Affiliation(s)
- Honghong Liu
- Department of Nuclear Medicine, the First Medical Center, Chinese PLA General Hospital
| | - Haodan Dang
- Department of Nuclear Medicine, the First Medical Center, Chinese PLA General Hospital
| | - Ruimin Wang
- Department of Nuclear Medicine, the First Medical Center, Chinese PLA General Hospital
| | - Shulin Yao
- Department of Nuclear Medicine, the First Medical Center, Chinese PLA General Hospital
| | - Yue Wu
- Siemens Healthineers, Ltd., Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, the First Medical Center, Chinese PLA General Hospital
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Trabucco SMR, Brascia D, Cazzato G, De Iaco G, Colagrande A, Signore F, Ingravallo G, Resta L, Marulli G. Pulmonary Sclerosing Pneumocytoma: A Pre and Intraoperative Diagnostic Challenge. Report of Two Cases and Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57060524. [PMID: 34071040 PMCID: PMC8224668 DOI: 10.3390/medicina57060524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 02/05/2023]
Abstract
Pulmonary sclerosing pneumocytoma is a rare benign pulmonary tumor of primitive epithelial origin. Because of the unspecific radiological features mimicking malignancies and its histological heterogeneity, the differential diagnosis with adenocarcinoma and carcinoid tumors is still challenging. We report our experience of two cases of sclerosing pneumocytoma, as well as a review of the literature. Immunohistochemical findings showed intense staining of the cuboidal epithelial cells for cytokeratin-pool and TTF-1, with focal positivity for progesterone receptors. Round and spindle cells expressed positivity for vimentin, TTF-1 and focally for the progesterone receptor. Cytologic diagnosis of pulmonary pneumocytoma requires the identification of its dual cell population, made up of abundant stromal cells and fewer surface cells. Since the pre- and intraoperative diagnosis should guide surgical decision making, obtaining a sufficient specimen size to find representative material in the cell block is of paramount importance.
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Affiliation(s)
- Senia Maria Rosaria Trabucco
- Pathology Unit, Department of Organ Transplantation and Emergency (DETO), University Hospital of Bari, 70124 Bari, Italy; (S.M.R.T.); (A.C.); (G.I.); (L.R.)
| | - Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70124 Bari, Italy; (D.B.); (G.D.I.); (F.S.)
| | - Gerardo Cazzato
- Pathology Unit, Department of Organ Transplantation and Emergency (DETO), University Hospital of Bari, 70124 Bari, Italy; (S.M.R.T.); (A.C.); (G.I.); (L.R.)
- Correspondence: (G.C.); (G.M.); Tel.: +34-0-5203641 (G.C.)
| | - Giulia De Iaco
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70124 Bari, Italy; (D.B.); (G.D.I.); (F.S.)
| | - Anna Colagrande
- Pathology Unit, Department of Organ Transplantation and Emergency (DETO), University Hospital of Bari, 70124 Bari, Italy; (S.M.R.T.); (A.C.); (G.I.); (L.R.)
| | - Francesca Signore
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70124 Bari, Italy; (D.B.); (G.D.I.); (F.S.)
| | - Giuseppe Ingravallo
- Pathology Unit, Department of Organ Transplantation and Emergency (DETO), University Hospital of Bari, 70124 Bari, Italy; (S.M.R.T.); (A.C.); (G.I.); (L.R.)
| | - Leonardo Resta
- Pathology Unit, Department of Organ Transplantation and Emergency (DETO), University Hospital of Bari, 70124 Bari, Italy; (S.M.R.T.); (A.C.); (G.I.); (L.R.)
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70124 Bari, Italy; (D.B.); (G.D.I.); (F.S.)
- Correspondence: (G.C.); (G.M.); Tel.: +34-0-5203641 (G.C.)
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Cai L, Wang T, Jiang L, Yang P, Hu J, Jiang J. Sclerosing pneumocytoma mixed with a columnar clear cell adenoma and a typical carcinoid: case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2599-2607. [PMID: 33165428 PMCID: PMC7642712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
Sclerosing pneumocytoma (SP) is a rare and benign tumor predominantly occurring in Asian women, easily misdiagnosed by imaging and pathologic frozen diagnosis during surgery because of its diverse histomorphology (4 structures, 2 types of cells). It may form multiple tumors. When SP is combined with carcinoid, adenoma, or other tumors (although rare), diagnosis is more complicated. SP mixed with carcinoid tumor is rare. At present, only 4 cases have been reported in English literature. Here, we report a case of sclerosing pneumocytoma combined not only with carcinoid, but also with clear cell adenoma of the lung. The patient was a 52-year-old female and CT found a nodule in the middle lobe of the right lung. SP was not excluded by intraoperative frozen section diagnosis. The above 3 components formed a 1.4 cm nodule. The related literature is reviewed to strengthen the understanding of SP, and aid clinicopathological diagnosis.
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Affiliation(s)
- Li Cai
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Ting Wang
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Lei Jiang
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Ping Yang
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Jinchen Hu
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Jing Jiang
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
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Juanola-Pla J, Tomàs MC, Castillo MPO. Sclerosing Pneumocytoma Presenting as Endobronchial Tumor With Negative Autofluorescence. Arch Bronconeumol 2020; 57:300. [PMID: 32792168 DOI: 10.1016/j.arbres.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Jordi Juanola-Pla
- Pulmonology Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain; High School of Health Sciences, Tecnocampus Mataró-Maresme, Pompeu Fabra University, Barcelona, Spain.
| | - Mireia Carmona Tomàs
- Family Medicine Department, CAP Cirera Molins, Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - M Pilar Ortega Castillo
- Pulmonology Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
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Maleki Z, Muller S, Layfield L, Siddiqui MT, Rekhtman N, Pantanowitz L. Pulmonary sclerosing pneumocytoma: Cytomorphology and immunoprofile. Cancer Cytopathol 2020; 128:414-423. [PMID: 32022435 DOI: 10.1002/cncy.22251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/18/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sclerosing pneumocytoma (SP) is a rare, benign pulmonary neoplasm. To the authors' knowledge, the current study is the first to evaluate the cytomorphology and immunoprofile of SP in a series. METHODS A total of 9 fine-needle aspiration cases of SP (7 of which were computed tomography guided and 2 of which were endobronchial ultrasound guided) including histopathology and immunohistochemistry were collected from 5 institutions. RESULTS The female-to-male ratio was 3.5:1, and the mean age of the patients was 54 years (range, 27-73 years). All cases presented as lung nodules, with a mean size of 2.2 cm (range, 1.1-5 cm), and were interpreted as atypical on rapid on-site evaluation. The final diagnoses were favor adenocarcinoma (1 case), well-differentiated lung adenocarcinoma (2 cases), low-grade epithelial neoplasm (2 cases), and sclerosing pneumocytoma (4 cases). Samples were moderately cellular, and consisted of round epithelioid cells with clear cell features, columnar cells, and spindle cells. A papillary arrangement with prominent hyalinized fibrovascular cores was the most common architectural pattern, followed by flat sheets and acinar formations. Tumor cells demonstrated mild, focally moderate nuclear pleomorphism with prominent nucleoli, hyperchromasia, nuclear elongation, nuclear overlap, and occasional nuclear inclusions and grooves. The background consisted of foamy macrophages (9 cases), hemosiderin pigment (6 cases), and lymphoid aggregates (3 cases) with no mitoses and/or necrosis. The surface cells and underlying round cells were positive for both thyroid transcription factor 1 and epithelial membrane antigen in all cases, which was the most notable immunohistochemical finding. CONCLUSIONS Cytomorphological findings of SP overlap with those of well-differentiated lung adenocarcinoma. Awareness of these cytomorphologic findings and the distinct immunoprofile of the 2 cell types found in SP should prevent a misdiagnosis and aggressive treatment.
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Affiliation(s)
- Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Muller
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lester Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri
| | - Momin T Siddiqui
- Pathology and Laboratory Medicine, Department of Pathology, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
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