Pulmonary sclerosing pneumocytoma (sclerosing haemangioma): Radical radiation therapy

Treatment and post-operative follow-up of pulmonary sclerosing pneumocytoma: A case report

Introduction and importance

Pulmonary sclerosing pneumocytoma (PSP) is a rare tumor thought to originate from respiratory epithelial cells. It is usually benign, but may rarely metastasize to lymph nodes. Surgeons face unique challenges in diagnosis and management of this condition, and ideal surgical management is yet to be established.

Case presentation

48-year-old woman with a 7 × 7 mm pulmonary lesion discovered incidentally on computerized tomography (CT) imaging, which grew to 9 mm over the following year. Seven years later, follow-up imaging revealed that the mass had grown to 1.3 cm in largest dimension. Surgery was recommended and the mass was resected via a right video-assisted thoracic surgery (VATS) middle lobectomy with mediastinal lymph node dissection. All lymph nodes were negative and the patient's postoperative course was unremarkable.

Clinical discussion

There are few evidence-based guidelines available on the treatment and postoperative surveillance of PSP. Research has shown comparable recurrence-free survival rates for sublobar resection and lobectomy, though recurrence can occur, especially following sublobar resection in larger or more centrally-located tumors. In absence of established guidelines, it was decided to follow this patient according to NCCN guidelines for surveillance of early-stage non-small cell lung cancer due to potential risk of recurrence.

Conclusion

This case report adds to the limited literature on PSP and depicts a possible treatment and postoperative follow-up plan. Right VATS middle lobectomy can effectively treat some cases of central PSP. In absence of established guidelines for postoperative follow-up of PSP, NCCN guidelines may outline one possible strategy for postoperative management.

Clinical Characteristics of Malignant Pulmonary Sclerosing Pneumocytoma Based on a Study of 46 Cases Worldwide

Objective

To analyze the clinical characteristics of patients with malignant pulmonary sclerosing pneumocytoma (PSP) with metastasis, recurrence, and growth and to improve clinicians’ understanding of PSP in patients with malignant tumor characteristics.

Methods

A total of 46 PSP patients with malignant tumor characteristics were identified in the literature search and compared with 38 patients with benign PSP diagnosed and treated in our hospital in the past 5 years. We explored the pathogenesis, clinical symptoms, diagnostic methods, treatment strategies and prognosis of PSP patients with malignant tumor.

Results

The characteristics of young age (≤41 years old), larger tumor (≥36mm), lymph node metastasis and distribution in East Asians are indicative of PSP with malignant potential. Such patients should undergo segmental resection or lobectomy, combined with necessary lymph node dissection or biopsy. All patients with PSP should have an entire course of follow-up management, because they may have an adverse prognosis such as recurrence, growth, metastasis, and even death.

Conclusion

PSP has the potential for malignancy. Anatomical lobectomy or segmental resection combined with lymph node dissection should be performed in PSP with some specific characteristics. Inappropriate diagnosis and treatment may lead to poor prognosis in PSP patients.

Pulmonary sclerosing pneumocytoma-a case series

Pulmonary sclerosing pneumocytoma (PSP) is a rare and interesting pulmonary tumour that presents a diagnostic challenge to the surgeon due to its bland symptomatology, indolent course, non-specific radiological features and ambiguous histopathological findings, which could lead to errors in management and prognostication. Herein, we present a series of 4 patients with PSP who were managed in our institution over a period of 8 years and briefly discuss relevant literature.

Pulmonary sclerosing pneumocytoma mimicking carcinoid on preoperative imaging in a 14-year-old female

Pulmonary sclerosing pneumocytoma is a rare benign neoplasm of the lung, commonly occurs in middle-aged persons with a marked female predominance. Earlier, it was known as sclerosing hemangioma. Here, we present a case of pulmonary sclerosing pneumocytoma which was diagnosed as carcinoid of the lung, based on imaging, in a 14-year-old female. Besides radiology, the uniqueness of this case lies in the young age (14 years) of the patient. She was presented with a 3.3 × 2.5 × 2.2 cm soft tissue density mass with a tiny speck of calcification in the anterior basal segment of the lower lobe of the right lung. Based on imaging findings on fluorodeoxyglucose positron emission tomography (FDG PET) scan and DOTANOC scan, a diagnosis of carcinoid was made. We performed a video-assisted thoracoscopic right lower lobectomy. Histopathological examination showed features of pulmonary sclerosing pneumocytoma. Surgery is an established method of treatment for pulmonary sclerosing pneumocytoma. Enucleation, lobectomy, sleeve resection are possible treatment options. To define the role of adjuvant therapy, further direct evidence is required. The metastatic potential of this disease is yet to be established.

Huge Pulmonary Sclerosing Pneumocytoma with Endobronchial Invasion: A Case Report with a Literature Review

Pulmonary sclerosing pneumocytoma (PSP) is a tumor of pneumocytic origin that is classified as a benign neoplasm. To date, aggressive behavior of this tumor has rarely been reported. Here, we describe a case of a 56-year-old woman with a huge, 19-cm PSP that resulted in mediastinal shift and showed microscopic endobronchial invasion and necrosis. The differential diagnosis included malignant mesenchymal tumors, such as solitary fibrous tumor; however, PSP was confirmed based on the characteristic thyroid transcription factor 1 positivity and membranous expression of Ki-67 on immunohistochemical staining of tumor cells.

Large pulmonary sclerosing pneumocytoma in a young female: A rare lung tumor

We report a case of a 28‐year‐old female who presented with a solid mass lesion in the right middle lobe (RML). A chest computed tomography (CT) scan showed a 3.5 cm sized round and solid mass between the medial and lateral segment of the RML. The patient underwent a percutaneous lung biopsy with CT scan guidance and pathological examination showed pulmonary sclerosing pneumocytoma. RML lobectomy was performed for definitive treatment. Here, we describe this rare lung disease which presented as a large homogeneous lesion. Pulmonary sclerosing pneumocytoma should be considered in the differential diagnosis of solitary lung tumor, even if the patient is young.

Pulmonary sclerosing pneumocytoma in an 18-year-old male patient: A case report and literature review

RATIONALE

Pulmonary sclerosing pneumocytoma (PSP) is a rare benign tumor of the lung, mostly presented in Asian middle-aged women. Initially, it was considered as a vascular origin tumor, but then research evidence showed that it was derived from natural epithelial tissue. On imaging, this tumor may be found as a solitary well-circumscribed lung parenchymal lesion, and is often located in juxtapleural or juxtafissural positions. On histopathology, it consists of cuboidal surface cells and stromal round cells, both of which are positive for thyroid transcription factor-1. Here we report a case of a young PSP male patient and review the relevant literature in order to improve our understanding of this disease.

PATIENT CONCERNS

An 18-year-old man was referred to our hospital after accidentally finding a lesion on chest X-ray. Contrast-enhanced computed tomography showed a soft tissue mass with homogeneous enhancement in the left lower lobe posterior segment.

DIAGNOSES

The diagnosis of PSPs was confirmed by histopathological examination.

INTERVENTIONS AND OUTCOMES

The patient underwent a thoracoscopic wedge resection and was followed-up after that. One month later, he had good performance status with no recurrent tumors.

LESSONS

PSP in a young man is really uncommon, and is confused with malignant tumors. A histopathological examination is considered as the diagnostic gold standard for this uncommon tumor. Surgery is the main treatment.

Pulmonary sclerosing pneumocytoma, a rare tumor of the lung

Pulmonary sclerosing pneumocytoma (PSP) is a rare benign pulmonary tumor. Usually diagnosed incidentally by chest X-ray or chest CT scan. We presented a case of PSP in a 50-year-old woman who was diagnosed with a nodular lesion in the right lung. Thoracotomy was used for the excision of the mass. Pathologic examination revealed no malignant cells. Immunohistochemical studies were performed. TTF-1 was (+), Napsin-A was found to be weakly (+). After surgical resection, the patient was followed up.

Sclerosing Pneumocytoma of the Lung: A Case Report

Pulmonary Sclerosing Pneumocytoma (PSP) is a rare tumour of the lung and is always benign. Diagnosis is made incidentally following chest X-ray or chest CT scan performed for other clinical conditions. We report a case of PSP in a seven-year-old girl who got admitted for evaluation of an anterior mediastinal mass. Clinically, thought of teratoma or other germ cell tumour the mass was excised and sent for histopathological examination. Grossly, we received a pneumonectomy specimen measuring 13x11x8 cm with a nodular firm grey white lesion in the medial aspect of lower and middle lobe measuring 7.5x5.5x5 cm. Macroscopically, pleura was involved and adherent to the lung. Microscopy showed, an ill-defined lesion in the lung with extensive fibrosis and lymphoplasmacytic infiltrate. The lesion was composed of round to oval cells with ill defined cell border, moderate eosinophilic cytoplasm and bland nuclei. A panel of Immunohistochemical (IHC) markers was performed and the lesional cells were positive for Epithelial Membrane Antigen (EMA) and Thyroid Transcription Factor-1 (TTF-1). The prognosis after surgical resection is good and the patient is doing well.