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Zhang Y, Yang X, Bi F, Wen L, Niu Y, Yang Y, Lin H, Yu X. CT-based radiomics for differentiating peripherally located pulmonary sclerosing pneumocytoma from carcinoid. Med Phys 2024; 51:4219-4230. [PMID: 38507783 DOI: 10.1002/mp.17037] [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] [Received: 09/05/2023] [Revised: 01/31/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Pulmonary sclerosing pneumocytoma (PSP) and pulmonary carcinoid (PC) are difficult to distinguish based on conventional imaging examinations. In recent years, radiomics has been used to discriminate benign from malignant pulmonary lesions. However, the value of radiomics based on computed tomography (CT) images to differentiate PSP from PC has not been well explored. PURPOSE We aimed to investigate the feasibility of radiomics in the differentiation between PSP and PC. METHODS Fifty-three PSP and fifty-five PC were retrospectively enrolled and then were randomly divided into the training and test sets. Univariate and multivariable logistic analyses were carried to select clinical predictor related to differential diagnosis of PSP and PC. A total of 1316 radiomics features were extracted from the unenhanced CT (UECT) and contrast-enhanced CT (CECT) images, respectively. The minimum redundancy maximum relevance and the least absolute shrinkage and selection operator were used to select the most significant radiomics features to construct radiomics models. The clinical predictor and radiomics features were integrated to develop combined models. Two senior radiologists independently categorized each patient into PSP or PC group based on traditional CT method. The performances of clinical, radiomics, and combined models in differentiating PSP from PC were investigated by the receiver operating characteristic (ROC) curve. The diagnostic performance was also compared between the combined models and radiologists. RESULTS In regard to differentiating PSP from PC, the area under the curves (AUCs) of the clinical, radiomics, and combined models were 0.87, 0.96, and 0.99 in the training set UECT, and were 0.87, 0.97, and 0.98 in the training set CECT, respectively. The AUCs of the clinical, radiomics, and combined models were 0.84, 0.92, and 0.97 in the test set UECT, and were 0.84, 0.93, and 0.98 in the test set CECT, respectively. In regard to the differentiation between PSP and PC, the combined model was comparable to the radiomics model, but outperformed the clinical model and the two radiologists, whether in the test set UECT or CECT. CONCLUSIONS Radiomics approaches show promise in distinguishing between PSP and PC. Moreover, the integration of clinical predictor (gender) has the potential to enhance the diagnostic performance even further.
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Affiliation(s)
- Yi Zhang
- Graduate Collaborative Training base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, Changsha, Hunan, China
| | - Xiaohuang Yang
- Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, Changsha, Hunan, China
| | - Feng Bi
- Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, Changsha, Hunan, China
| | - Lu Wen
- Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, Changsha, Hunan, China
| | - Yue Niu
- Graduate Collaborative Training base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yanhui Yang
- Graduate Collaborative Training base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Huashan Lin
- Department of Pharmaceutical Diagnosis, General Electric (GE) Healthcare, Changsha, Hunan, China
| | - Xiaoping Yu
- Graduate Collaborative Training base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine & Hunan Cancer Hospital, Central South University, Changsha, Hunan, China
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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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Liang J, Du Q, Ye X, Huang W. Pulmonary sclerosing pneumocytoma containing spindle cells with sarcomatoid features: a case report with literature review. Diagn Pathol 2023; 18:16. [PMID: 36759857 PMCID: PMC9912602 DOI: 10.1186/s13000-023-01296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Pulmonary sclerosing pneumocytoma (PSP) is an uncommon benign neoplasm originated from pneumocyte and PSP with malignant transformation is extremely rare. CASE PRESENTATION We report a case of PSP of a 65-year-old male patient presented as a lobulated mass in the upper lobe of the left lung, in which part of the stromal round cells transformed to spindle cells with sarcomatoid features and showed no specific differentiation. The patient underwent partial lobectomy without further treatment. No recurrence and metastasis was found after eight month's follow up. CONCLUSIONS To our knowledge, this is the first case of PSP with sarcomatoid malignant transformation devoid of differentiation. Our case adds the evidence in that a subset of PSP bear malignant potential and more studies are needed in order to determine the treatment and prognosis to such patients.
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Affiliation(s)
- Jing Liang
- grid.506261.60000 0001 0706 7839Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Qiang Du
- grid.506261.60000 0001 0706 7839Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Xiaoxing Ye
- grid.506261.60000 0001 0706 7839Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116 China
| | - Wenting Huang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. .,Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
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Ma L, Peterson EA, Shin IJ, Muesse J, Marino K, Steliga MA, Atiq O, Arnaoutakis K, Wardell C, Wooldridge J, Prior F, Johann DJ. An advanced molecular medicine case report of a rare human tumor using genomics, pathomics, and radiomics. Front Genet 2023; 13:987175. [PMID: 36846293 PMCID: PMC9951004 DOI: 10.3389/fgene.2022.987175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/01/2022] [Indexed: 02/12/2023] Open
Abstract
Background: Pulmonary Sclerosing Pneumocytoma (PSP) is a rare tumor of the lung with a low malignant potential that primarily affects females. Initial studies of PSP focused primarily on analyzing features uncovered using conventional X-ray or CT imaging. In recent years, because of the widespread use of next-generation sequencing (NGS), the study of PSP at the molecular-level has emerged. Methods: Analytical approaches involving genomics, radiomics, and pathomics were performed. Genomics studies involved both DNA and RNA analyses. DNA analyses included the patient's tumor and germline tissues and involved targeted panel sequencing and copy number analyses. RNA analyses included tumor and adjacent normal tissues and involved studies covering expressed mutations, differential gene expression, gene fusions and molecular pathways. Radiomics approaches were utilized on clinical imaging studies and pathomics techniques were applied to tumor whole slide images. Results: A comprehensive molecular profiling endeavor involving over 50 genomic analyses corresponding to 16 sequencing datasets of this rare neoplasm of the lung were generated along with detailed radiomic and pathomic analyses to reveal insights into the etiology and molecular behavior of the patient's tumor. Driving mutations (AKT1) and compromised tumor suppression pathways (TP53) were revealed. To ensure the accuracy and reproducibility of this study, a software infrastructure and methodology known as NPARS, which encapsulates NGS and associated data, open-source software libraries and tools including versions, and reporting features for large and complex genomic studies was used. Conclusion: Moving beyond descriptive analyses towards more functional understandings of tumor etiology, behavior, and improved therapeutic predictability requires a spectrum of quantitative molecular medicine approaches and integrations. To-date this is the most comprehensive study of a patient with PSP, which is a rare tumor of the lung. Detailed radiomic, pathomic and genomic molecular profiling approaches were performed to reveal insights regarding the etiology and molecular behavior. In the event of recurrence, a rational therapy plan is proposed based on the uncovered molecular findings.
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Affiliation(s)
- Li Ma
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Department of Information Science, University of Arkansas at Little Rock, Little Rock, AR, United States
| | - Erich A. Peterson
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Ik Jae Shin
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jason Muesse
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Katy Marino
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mathew A. Steliga
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Omar Atiq
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Konstantinos Arnaoutakis
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Christopher Wardell
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jacob Wooldridge
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Donald J. Johann
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States,*Correspondence: Donald J. Johann,
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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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Zhang W, Cui D, Liu Y, Shi K, Gao X, Qian R. Clinical Characteristics of Malignant Pulmonary Sclerosing Pneumocytoma Based on a Study of 46 Cases Worldwide. Cancer Manag Res 2022; 14:2459-2467. [PMID: 35991678 PMCID: PMC9384969 DOI: 10.2147/cmar.s377161] [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: 06/02/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Weidong Zhang
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou City, Henan Province, People's Republic of China
| | - Dong Cui
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou City, Henan Province, People's Republic of China
| | - Yaqian Liu
- Medical Records and Statistics Room, Henan Provincial Chest Hospital, Zhengzhou City, Henan Province, People's Republic of China
| | - Kefeng Shi
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou City, Henan Province, People's Republic of China
| | - Xia Gao
- Department of Cardiovascular Surgery, Henan Provincial Chest Hospital, Zhengzhou City, Henan Province, People's Republic of China
| | - Rulin Qian
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou City, Henan Province, People's Republic of China
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Pulmonary sclerosing pneumocytoma: clinical features and prognosis. World J Surg Oncol 2022; 20:140. [PMID: 35490241 PMCID: PMC9055737 DOI: 10.1186/s12957-022-02603-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/14/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pulmonary sclerosing pneumocytoma is a kind of rare benign pulmonary tumor with potential malignancy. The clinical features, risk factors for prognosis, and optimal treatment have not been identified yet. This study aimed to investigate the clinical features and prognosis of pulmonary sclerosing pneumocytoma. METHODS We retrospectively performed a review of pulmonary sclerosing pneumocytoma patients in West China Hospital from 2009 to 2019. The basic characteristics, treatment regimens, operation detail, postoperative variables, and follow-up time were recorded for each case. Differences in features between patients undergoing lobectomy and segmentectomy were compared. We also performed a case review and summarized reported clinical features in former studies. RESULTS Altogether 61 pulmonary sclerosing pneumocytoma patients were retrospectively reviewed. Fifty-six patients were female and 5 were male. The patients' median age was 51 (23-73). Seven (11.48%) patients had smoking history. Twenty tumors were located in the right lung [upper lobe (n = 7), middle (n = 2), and lower (n = 11)] and 41 in the left [upper (n = 12) and lower (n = 29)]. The median tumor size was 2 (0.9-7) cm. Thirty-six (59.02%) patients underwent sublobectomy (segmentectomy or wedge resection) whereas 25 (40.98%) underwent lobectomy. All patients recovered uneventfully, and no perioperative mortality was identified. Sublobectomy showed a trend towards reduced chest tube duration and shorter postoperative hospital stays compared with lobectomy. CONCLUSIONS The findings showed good prognosis of pulmonary sclerosing pneumocytoma and proved its benign characteristics. Sublobectomy showed advanced efficacy regarding chest tube duration and postoperative hospital stay compared with lobectomy.
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Wang Q, Lu C, Jiang M, Li M, Yang X, Zhang L, He Y, Mao C, Fu P, Yang Y, Xiao H. Case Report and Literature Review: Pulmonary Sclerosing Pneumocytoma With Multiple Metastases Harboring AKT1 E17K Somatic Mutation and TP53 C176Y Germline Mutation. Front Med (Lausanne) 2021; 8:655574. [PMID: 34568352 PMCID: PMC8455843 DOI: 10.3389/fmed.2021.655574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Pulmonary Sclerosing Pneumocytoma (PSP) is considered as a benign tumor, although a few cases have been reported to have multiple lesions, recurrence, and even regional lymph nodes (LNs) metastasis. Here, we report a case of PSP with atypical histologic features and malignant biological behavior, and explore its molecular genetic changes. The 23-year-old male showed a 6.5-cm pulmonary nodule in the right middle lobe (RML) and enlarged media stinal LNs. He underwent thoracoscopic RML lobectomy, systematic LNs dissection, and mediastinal lymphadenectomy. The metastases to the cervical LNs and liver were detected in a short period and then resected. Postoperative pathological examination confirmed the diagnosis of PSP in all the lesions, based on the histological characteristics and immune phenotypes. Furthermore, whole-exome sequencing identified both AKT1 E17K somatic mutation and TP53 C176Y germline mutation in this case. Thus, we presented an extremely rare case of atypical PSP with rapid recurrence and multiply metastases, which can easily be misdiagnosed as primary lung cancer. In addition, PSP-specific AKT1 E17K somatic E17K somatic mutation accompanied with TP53 C176Y germline mutation may contribute to the malignant clinical course of this tumor.
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Affiliation(s)
- Qiushi Wang
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chunlin Lu
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
| | - Minrui Jiang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Mengxia Li
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao Yang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Lei Zhang
- Genecast Precision Medicine Technology Institute, Beijing, China
| | - Yong He
- Department of Respiratory Disease, Daping Hospital, Army Medical University, Chongqing, China
| | - Chengyi Mao
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ping Fu
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ying Yang
- Genecast Precision Medicine Technology Institute, Beijing, China
| | - Hualiang Xiao
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
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Zhang W, Liu Y, Chai Y, Shi K, Chen J, Shi D, Wu X. Case Report: Rare Pulmonary Sclerosing Pneumocytoma: Large, Multiple, Metastatic, and Fatal. Front Med (Lausanne) 2021; 8:661032. [PMID: 34485321 PMCID: PMC8415542 DOI: 10.3389/fmed.2021.661032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Pulmonary sclerosing pneumocytoma (PSP) is a rare benign or low-grade malignant tumor, but it has the potential to present with multiple lesions, lymph node metastasis, extra-pulmonary metastasis, recurrence and even cause death. Herein, a case of PSP that was huge, presented with multiple lesions and had lymph node as well as extrapulmonary metastases (liver, abdominal cavity, bones) is reported for the first time. This patient was also the first one to die of respiratory and circulatory failure caused by the PSP tumor and its metastases which compressed the mediastinal tissue.
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Affiliation(s)
- Weidong Zhang
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yuanyuan Liu
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yamei Chai
- Department of Pathology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Kefeng Shi
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jialing Chen
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Dongfeng Shi
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Xiaoming Wu
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
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