1
|
Manini C, Vezzini S, Conte A, Sciacca G, Infantino A, Santos-Pereira P, López JI. Revisiting Pulmonary Sclerosing Pneumocytoma. Clin Pract 2024; 14:1440-1450. [PMID: 39051310 PMCID: PMC11270357 DOI: 10.3390/clinpract14040116] [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: 05/06/2024] [Revised: 06/20/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
Pulmonary sclerosing pneumocytoma (PSP) is a quite rare tumor outside Eastern countries. This rarity, together with a wide histological appearance, makes its correct identification a diagnostic challenge for pathologists under the microscope. Historically, PSP was considered a vascular-derived neoplasm (sclerosing hemangioma), but its immunohistochemical profile clearly supports its epithelial origin. No specific molecular fingerprint has been detected so far. This short narrative revisits the clinical, histological, immunohistochemical, and molecular aspects of this tumor, paying special attention to some controversial points still not well clarified, i.e., clinical aggressiveness and metastatic spread, multifocality, the supposed development of sarcomatoid change in a subset of cases, and tumor associations with lung adenocarcinoma and/or well-differentiated neuroendocrine hyperplasia/tumors. The specific diagnostic difficulties on fine-needle aspiration cytology/biopsy and perioperative frozen sections are also highlighted. Finally, a teaching case of tumor concurrence of lung adenocarcinoma, neuroendocrine lesions, and PSP, paradigmatic of tumor association in this context, is also presented.
Collapse
Affiliation(s)
- Claudia Manini
- Department of Pathology, San Giovanni Bosco Hospital, ASL Città di Torino, 10154 Turin, Italy; (C.M.); (P.S.-P.)
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10124 Turin, Italy
| | - Simone Vezzini
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (S.V.); (A.C.); (G.S.)
| | - Antonella Conte
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (S.V.); (A.C.); (G.S.)
| | - Giuseppe Sciacca
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (S.V.); (A.C.); (G.S.)
| | - Alessandro Infantino
- Faculty of Medicine and Dentistry, University of Rome “La Sapienza”, 00185 Rome, Italy;
| | - Poliana Santos-Pereira
- Department of Pathology, San Giovanni Bosco Hospital, ASL Città di Torino, 10154 Turin, Italy; (C.M.); (P.S.-P.)
| | - José I. López
- Biobizkaia Health Research Institute, 48903 Barakaldo, Spain
| |
Collapse
|
2
|
He P, Wang J, Guo J, Li S, Zhang W. Multiple pulmonary sclerosing pneumocytoma, based on a study of 36 cases worldwide. Sci Rep 2024; 14:12242. [PMID: 38806602 PMCID: PMC11133446 DOI: 10.1038/s41598-024-63185-7] [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: 10/09/2023] [Accepted: 05/27/2024] [Indexed: 05/30/2024] Open
Abstract
To analyze the clinical characteristics and to improve clinicians' understanding of multiple pulmonary sclerosing pneumocytoma (PSP) patients. A total of 36 PSP patients with multiple tumor characteristics were identified from the literature search. They were compared with 43 solitary PSP patients diagnosed and treated in our hospital in the past 5 years. Thus, the pathogenesis, clinical symptoms, diagnosis methods, treatment strategies, and prognosis of pulmonary sclerosing pneumocytoma (PSP) patients with multiple tumors were explored. Patients with multiple PSP are mostly distributed in Asia (88.89%) and are females (83.33%). PSP can be located in any one lobe (19.44%), or grow across ipsilateral lobes (44.44%), or even, bilateral lobes (36.11%). It can be accompanied by metastasis (9.09%) and is prone to misdiagnosis (27.78%). Compared with solitary PSP, the occurrence age of multiple PSP was younger (mean ± standard deviation [SD]: 40.36 ± 18.12: 51.28 ± 12.74 years), but there was no significant difference in sex, tumor size (mean ± SD: 43.54 ± 46.18: 30.56 ± 17.62 mm), or symptoms. Individualized surgical resection is required for treatment, including pneumonectomy (17.65%), lobectomy (23.53%), subpulmonary lobectomy (38.24%), or combined lobectomy (5.88%). Multiple PSP is relatively rare. Surgical resection within a limited time should be the main treatment for such patients. The prognosis of patients with multiple PSP is generally good, but inappropriate diagnosis and treatment plans may lead to poor prognosis.
Collapse
Affiliation(s)
- Pan He
- Department of Cardiothoracic Surgery, Henan Provincial Chest Hospital (Chest Hospital of Zhengzhou University), Zhengzhou, Henan, China
| | - Jianwei Wang
- Department of Cardiothoracic Surgery, Henan Provincial Chest Hospital (Chest Hospital of Zhengzhou University), Zhengzhou, Henan, China
| | - Jiong Guo
- Department of Cardiothoracic Surgery, Henan Provincial Chest Hospital (Chest Hospital of Zhengzhou University), Zhengzhou, Henan, China
| | - Shunqi Li
- Department of Cardiothoracic Surgery, Henan Provincial Chest Hospital (Chest Hospital of Zhengzhou University), Zhengzhou, Henan, China
| | - Weidong Zhang
- Department of Cardiothoracic Surgery, Henan Provincial Chest Hospital (Chest Hospital of Zhengzhou University), Zhengzhou, Henan, China.
- Henan Provincial Chest Hospital, Room 1, Weiwu Road, Zhengzhou, 450003, Henan, China.
| |
Collapse
|
3
|
Li Y, Yang L, Gu X, Wang Y, Deng H, Feng H, Zhang N, Wang M, Wang Q, Shi G. Magnetic resonance imaging findings of pulmonary sclerosing pneumocytoma: a case report and literature review. Front Oncol 2023; 13:1158328. [PMID: 37727218 PMCID: PMC10505615 DOI: 10.3389/fonc.2023.1158328] [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: 02/03/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023] Open
Abstract
Background Pulmonary sclerosing pneumocytoma (PSP) is a rare lung tumor that is mostly isolated and commonly reported among middle-aged East Asian women. Recently, Immunohistochemistry (IHC) analysis has suggested that PSP is of primitive epithelial origin, most likely derived from type II alveolar air cells. Patients with PSP are generally asymptomatic and usually detected for other unrelated reasons during routine imaging. Several studies have already investigated the computed tomography (CT) features of PSP and their correlation with pathology. Magnetic resonance imaging (MRI) is a radiation-free imaging technique with important diagnostic value for specific pulmonary nodules. However, very few case reports or studies focus on the MRI findings of PSP. Case report We reported a case of an asymptomatic 56-year-old female with a solitary, well-defined soft-tissue mass in the lower lobe of the left lung. The mass showed iso-to-high signal intensity (SI) than muscle on T1-weighted image (T1WI) and T2-weighted image (T2WI) and a much higher SI on fat-suppressed T2WI, diffusion-weighted image, and apparent diffusion coefficient image. Contrast-enhanced fat-suppressed T1WI revealed noticeable inhomogeneous progressive enhancement throughout the mass. The mass revealed early enhancement without a significant peak, followed by a plateau pattern on dynamic contrast-enhanced MRI images. The patient underwent left basal segmentectomy via thoracoscopic surgery. Histopathology and IHC results of the surgical specimen confirmed that it was a PSP. We concluded that the MRI findings of PSP might adequately reflect the different components within the tumor and aid clinicians in preoperative diagnosis and assessment. To the best of our knowledge, this is the most comprehensive case report on the MRI findings of PSP. Conclusion The MRI findings of PSP correspond to its histopathological features. Here, we present a case of PSP with the most comprehensive MRI findings, emphasizing the importance of multiple-sequence MRI in diagnosing PSP.
Collapse
Affiliation(s)
- Yang Li
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li Yang
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaolong Gu
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yaning Wang
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huiyan Deng
- Department of Pathology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital , Shijiazhuang, Hebei, China
| | - Hui Feng
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ning Zhang
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Mingbo Wang
- Department of Thoracic Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei, China
| | - Qi Wang
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gaofeng Shi
- Department of Computed Tomography and Magnetic Resonance Imaging, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
4
|
Muacevic A, Adler JR, Lin S, Mitchell M. Sclerosing Pneumocytoma With Pulmonary Sarcoidosis: A Case Report. Cureus 2022; 14:e31265. [PMID: 36505138 PMCID: PMC9731799 DOI: 10.7759/cureus.31265] [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] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Pulmonary sclerosing pneumocytoma, formally named pulmonary sclerosing hemangioma, is a rare benign tumor with malignant potential often identified as solid pulmonary nodules. Sarcoidosis is an inflammatory, multisystemic disease of unknown cause with a wide range of clinical manifestations. The disorder is characterized by the formation of noncaseating granulomas in virtually any organ in the body. We present a case of a patient presenting with fever, weight loss, and respiratory symptoms found to have both a sclerosing pneumocytoma and pulmonary sarcoidosis. A diagnosis was made following the lobectomy. The patient was followed for two years with stable lymphadenopathy while remaining asymptomatic.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
A female with solitary fibrous tumor pleura mimicking pulmonary sclerosing pneumocytoma in low resource setting: A case report. Int J Surg Case Rep 2022; 93:106928. [PMID: 35298985 PMCID: PMC8927691 DOI: 10.1016/j.ijscr.2022.106928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/08/2022] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Solitary fibrous tumor of pleura (SFTP) is a rare condition. Clinical symptoms and non-specific radiological features in both tumors make preoperative diagnosis difficult to establish. Case presentation A Javanese 47-year-old female complained of chest pain and shortness of breath which an X-ray and CT-Scan of the thorax showed giant cell metastases in the lung. Signs and symptoms indicate pulmonary sclerosing pneumocytoma (PSP) and the patient underwent thoracic surgery which was first performed with angiographic embolization. Furthermore, an anatomical pathology analysis was performed with suspected SFTP, supported by the IHC test, which found CD34 (+), EMA (−), and S100 (−). Thoracic surgery followed by radiotherapy and chemotherapy is recommended in SFTP patients. Discussion The SFTP and PSP have non-specific clinical symptoms and radiological features. Anatomic pathology and IHC test are definitive diagnostic tools from SFTP and PSP. Establishing a preoperative diagnosis of SFTP and PSP is quite difficult. Surgical resection is the treatment of choice for both. Conclusion The comparison of SFTP and PSP can be seen results of the anatomical pathology analysis and IHC test. Solitary fibrous tumor of pleura (SFTP) and pulmonary sclerosing pneumocytoma (PSP) are difficult to distinguish in a low-resource setting. SFTP and PSP can be differentiated using an immunohistopathology test (cluster of differentiation 34/CD54 was positive). Management of SFTP and PSP are both similar to surgery (thoracotomy with a subcostal incision).
Collapse
|
7
|
Luo C, Song Y, Liu Y, Wang R, Gao J, Yue S, Ding C. Analysis of the value of enhanced CT combined with texture analysis in the differential diagnosis of pulmonary sclerosing pneumocytoma and atypical peripheral lung cancer: a feasibility study. BMC Med Imaging 2022; 22:16. [PMID: 35105314 PMCID: PMC8808962 DOI: 10.1186/s12880-022-00745-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a rare benign lung tumour, pulmonary sclerosing pneumocytoma (PSP) is often misdiagnosed as atypical peripheral lung cancer (APLC) on routine imaging examinations. This study explored the value of enhanced CT combined with texture analysis to differentiate between PSP and APLC. METHODS Forty-eight patients with PSP and fifty patients with APLC were retrospectively enrolled. The CT image features of the two groups of lesions were analysed, and MaZda software was used to evaluate the texture of CT venous phase thin-layer images. Independent sample t-test, Mann-Whitney U tests or χ2 tests were used to compare between groups. The intra-class correlation coefficient (ICC) was used to analyse the consistency of the selected texture parameters. Spearman correlation analysis was used to evaluate the differences in texture parameters between the two groups. Based on the statistically significant CT image features and CT texture parameters, the independent influencing factors between PSP and APLC were analysed by multivariate logistic regression. Extremely randomized trees (ERT) was used as the classifier to build models, and the models were evaluated by the five-fold cross-validation method. RESULTS Logistic regression analysis based on CT image features showed that calcification and arterial phase CT values were independent factors for distinguishing PSP from APLC. The results of logistic regression analysis based on CT texture parameters showed that WavEnHL_s-1 and Perc.01% were independent influencing factors to distinguish the two. Compared with the single-factor model (models A and B), the classification accuracy of the model based on image features combined with texture parameters was 0.84 ± 0.04, the AUC was 0.84 ± 0.03, and the sensitivity and specificity were 0.82 ± 0.13 and 0.87 ± 0.12, respectively. CONCLUSION Enhanced CT combined with texture analysis showed good diagnostic value for distinguishing PSP and APLC, which may contribute to clinical decision-making and prognosis evaluation.
Collapse
Affiliation(s)
- Chenglong Luo
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Yiman Song
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Yiyang Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Rui Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Songwei Yue
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Changmao Ding
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Boland JM, Lee HE, Barr Fritcher EG, Voss JS, Jessen E, Davila JI, Kipp BR, Graham RP, Maleszewski JJ, Yi ES. Molecular Genetic Landscape of Sclerosing Pneumocytomas. Am J Clin Pathol 2021; 155:397-404. [PMID: 33145590 DOI: 10.1093/ajcp/aqaa136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Sclerosing pneumocytomas are rare pulmonary neoplasms that are typically benign. However, rare patients experience progressive disease, and therapy targeting specific genetic underpinnings could be an attractive therapeutic option. Recent studies have found recurrent AKT 1 mutations in sclerosing pneumocytoma, but little is known about whether oncogenic fusion genes may also be present. METHODS To better understand the genetic background, 10 sclerosing pneumocytomas were subjected to next-generation sequencing cancer mutation panel testing (n = 9) and/or RNA sequencing (n = 3). The patients were all women (average age, 47 years; range, 17-74 years). RESULTS Eight patients had solitary sclerosing pneumocytomas, while one had two tumors, and one had many bilateral tumors. Recurrent mutations were noted in genes involved in the mTOR pathway, including AKT1, PIK3R1, and PTEN. AKT1 alterations were particularly common, present in 78%. No recurrent genetic fusions were identified. The patient in our study with multiple bilateral lesions was treated with the mammalian target of rapamycin (mTOR) inhibitor everolimus, with no objective radiographic evidence of treatment response after 4 months. CONCLUSIONS Our data further support that abnormal activation of the mTOR pathway is a consistent genetic event in sclerosing pneumocytoma. This warrants further exploration to determine if mTOR pathway inhibitors may be effective in patients with metastatic or recurrent disease.
Collapse
Affiliation(s)
- Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Hee Eun Lee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Jesse S Voss
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Erik Jessen
- Division of Biomedical Statistics and Informatics, Department of Research Services, Mayo Clinic, Rochester, MN
| | - Jaime I Davila
- Division of Biomedical Statistics and Informatics, Department of Research Services, Mayo Clinic, Rochester, MN
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Eunhee S Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| |
Collapse
|
10
|
Le HY, Pham DP, Nguyen KT, Hoang VA, Trinh TS, Do Q. Pulmonary sclerosing pneumocytoma in an 18-year-old male patient: A case report and literature review. Medicine (Baltimore) 2020; 99:e20869. [PMID: 32590790 PMCID: PMC7329001 DOI: 10.1097/md.0000000000020869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Huu Y Le
- Center of Respiratory Diseases, 103 Military Hospital
| | | | | | - Van Ai Hoang
- Military institute of clinical embryology and histology, Vietnam Military Medical University, Hanoi, Vietnam
| | - The Son Trinh
- Military institute of clinical embryology and histology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Quyet Do
- Director of Vietnam Military Medical University, Hanoi, Vietnam
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
LuLu X, Jian S. Concomitance of pulmonary spindle cell carcinoma and sclerosing pneumocytoma in a woman: A case report. Medicine (Baltimore) 2019; 98:e18416. [PMID: 31861007 PMCID: PMC6940139 DOI: 10.1097/md.0000000000018416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Pulmonary spindle cell carcinoma (PSCC) is a rare subset of pulmonary sarcomatoid carcinoma. PSCC is aggressive and has a poor prognosis. Pulmonary sclerosing pneumocytoma (PSP) is an asymptomatic slow-growing benign tumor, which usually occurs in middle-aged women. PATIENT CONCERNS Herein, we report a case of solitary PSCC, occurring concomitantly with PSP in a 74-year-old woman. The patient visited our institution with productive purulent cough, dyspnea after activity, and hemoptysis. Enhanced computed tomography revealed an inhomogeneous enhanced mass with central low-attenuation in the right upper lobe (RUL). The mass located in the right lower lobe (RLL) exhibited homogeneous enhancement. DIAGNOSIS These lesions were subsequently diagnosed as PSCC in the RUL and PSP in the RLL, following postoperative pathological examination. INTERVENTIONS We performed lobectomy for the RUL and wedge resection for the RLL in one procedure. OUTCOMES The patient did not experience complications after surgery. No radiological evidence of recurrence was observed on follow-up computed tomography performed within 7 months after the procedure. LESSONS This case fully reflects the importance of the differential preoperative diagnosis of benign and malignant solitary pulmonary nodules. However, a rare and aggressive malignant tumor may have imaging features typical of a lung abscess, which should be treated carefully.
Collapse
|
13
|
Sakai T, Miyoshi T, Umemura S, Suzuki J, Nakasone S, Okada S, Tane K, Aokage K, Goto K, Motoi N, Ishii G, Tsuboi M. Large pulmonary sclerosing pneumocytoma with massive necrosis and vascular invasion: a case report. Oxf Med Case Reports 2019; 2019:5539001. [PMID: 31428771 PMCID: PMC6660061 DOI: 10.1093/omcr/omz066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/24/2019] [Accepted: 05/30/2019] [Indexed: 12/05/2022] Open
Abstract
Pulmonary sclerosing pneumocytoma (PSP) is pathologically classified as an adenoma and behaves in a benign manner. However, some cases of PSP displayed pathologically malignant behavior, such as lymph node metastasis and necrosis. A 64-year-old woman was referred to our hospital complaining of a cough and breathlessness. Histopathological analysis of the resected specimen by left pneumonectomy and lymph node dissection revealed a large PSP measuring 15 × 14 cm in size, with massive necrosis and vascular invasion. This case was the largest ever reported and suggested that clinico-histological presentation of PSP sometimes showed an aggressive phenotype like advanced lung cancer.
Collapse
Affiliation(s)
- Takashi Sakai
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan.,Division of Chest Surgery, Department of Surgery, Toho University Graduate School of Medicine, Ota, Tokyo, Japan
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shigeki Umemura
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Jun Suzuki
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Department of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Shoko Nakasone
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Satoshi Okada
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Noriko Motoi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Chuo, Tokyo, Japan
| | - Genichiro Ishii
- Department of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| |
Collapse
|
14
|
Xu J, Dong Y, Yin G, Jiang W, Yang Z, Xu W, Zhu L. 18 F-FDG PET/CT imaging: A supplementary understanding of pulmonary sclerosing pneumocytoma. Thorac Cancer 2019; 10:1552-1560. [PMID: 31131992 PMCID: PMC6610286 DOI: 10.1111/1759-7714.13100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022] Open
Abstract
Background We sought to investigate the clinical features and 18F‐FDG PET/CT characteristics of pulmonary sclerosing pneumocytoma (PSP). Methods We retrospectively reviewed and comparatively analyzed 18F‐FDG PET/CT imaging results of 22 patients with diagnosed PSP in our hospital from November 2009 to September 2015. Results The SUVmax in tumors was positively correlated with tumor size in typical PSPs (R = 0.806, R2 = 0.650, P = 0.001); however, the SUVmax in tumors had no significant correlation with tumor size of atypical PSPs (R = 0.479, R2 = 0.229, P = 0.162), and the degree of correlation between them attenuated when atypical PSPs were included (R = 0.518, R2 = 0.268, P = 0.011). A majority (90%) of atypical PSPs were found in males. Symptomatic patients showed a higher SUVmax than the asymptomatic group (5.68 ± 3.63 vs. 2.76 ± 1.18, respectively, P = 0.002). Conclusion Tumor size and clinical features may be associated with increased FDG uptake in PSPs. Morphological differences may affect the correlation between tumor size and SUVmax in PSPs. The atypical form of PSP may be more common in men.
Collapse
Affiliation(s)
- Jie Xu
- Department of Senior Ward, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Youwen Dong
- Imaging Center, The Affiliated Hospital of Jining Medical University, Jining, China
| | - Guotao Yin
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wei Jiang
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhen Yang
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lei Zhu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| |
Collapse
|
15
|
Yuan ZQ, Wang Q, Bao M. Symptomatic pulmonary sclerosing hemangioma: a rare case of a solitary pulmonary nodule in a woman of advanced age. J Int Med Res 2019; 47:2302-2308. [PMID: 30971157 PMCID: PMC6567762 DOI: 10.1177/0300060519840898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Pulmonary sclerosing hemangioma (PSH) is a rare tumor that usually develops in middle-aged Asian women. PSH has four histological types (hemorrhagic, sclerotic, solid, and papillary) and often grows slowly in a lower lobe of the lung. Preoperative misdiagnosis frequently occurs because of the absence of specific clinical manifestations and imaging findings. Few reports have described PSH in women of advanced age. Case presentation: A 75-year-old woman presented to our hospital in China with a 5-day history of productive cough and intermittent hemoptysis. Computed tomography indicated bronchiectasis and a large mass in the left inferior lobe of the lung. Treatment of the bronchiectasis provided no symptom relief. The hemoptysis resolved following left lower pulmonary lobectomy, and PSH was pathologically diagnosed following surgery. At the time of this writing (after 6 months of follow-up), the tumor had not recurred, no metastases had been detected, and close follow-up was ongoing. Conclusions Both bronchiectasis and PSH can cause hemoptysis. This case demonstrates that PSH should be included as a differential diagnosis of hemoptysis in women of advanced age. For patients with chronic hemoptysis, the diagnosis of PSH should be considered if the therapeutic effect of bronchiectasis is poor.
Collapse
Affiliation(s)
- Zhu-Qing Yuan
- 1 Department of Respiratory Medicine, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Hubei, China
| | - Qian Wang
- 2 Department of Intensive Care Unit, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Hubei, China
| | - Min Bao
- 1 Department of Respiratory Medicine, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Hubei, China
| |
Collapse
|
16
|
Wang Z, Yang MQ, Huang WJ, Zhang D, Xu HT. Sclerosing pneumocytoma mixed with a typical carcinoid tumor: A case report and review of literature. Medicine (Baltimore) 2019; 98:e14315. [PMID: 30702609 PMCID: PMC6380861 DOI: 10.1097/md.0000000000014315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RATIONALE Sclerosing pneumocytoma accompanied with other type of tumor in one patient is very rare. Here, we report a case of a sclerosing pneumocytoma mixed with a typical carcinoid tumor in a same neoplasm. PATIENT CONCERNS A 55-year-old woman incidentally detected a space-occupying lesion of right lung in routine health examination. The patient was asymptomatic and there were no positive findings in routine laboratory examination, physical examination, and pulmonary function test. Computed tomography revealed a solitary round mass in the middle lobe of the right lung. DIAGNOSIS The lesion was diagnosed as a sclerosing pneumocytoma accompanied with a typical carcinoid tumor of the right lung. INTERVENTION The patient underwent thoracoscopic lobectomy in our hospital. OUTCOMES The postoperative course was uneventful. LESSONS This case is rare and noteworthy for a lesion containing two different types of neoplasms, which may cause diagnostic difficulties.
Collapse
Affiliation(s)
- Zhao Wang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
- Department of Pathology, General Hospital of Heilongjiang Land Reclamation Bureau, Harbin
| | - Mai-Qing Yang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
- Department of Pathology, Changyi People's Hospital, Changyi, China
| | - Wen-Jing Huang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
| | - Di Zhang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
| | - Hong-Tao Xu
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
| |
Collapse
|
17
|
Sclerosing Pneumocytoma: A Ten-Year Experience at a Western Balkan University Hospital. ACTA ACUST UNITED AC 2019; 55:medicina55020027. [PMID: 30691016 PMCID: PMC6409643 DOI: 10.3390/medicina55020027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/02/2022]
Abstract
Background and objective: Sclerosing pneumocytoma is a rare, benign tumor of the lung that represents a diagnostic challenge due to the diversity of pathohistological findings. The aim of this study was to present a 10-year experience with sclerosing pneumocytoma of a large center for the diagnosis and treatment of pulmonary diseases, and to emphasize differential diagnostic dilemmas as a potential source of errors. Material and Methods: This represents a retrospective study of six patients diagnosed and treated with sclerosing pneumocytoma in the 10-year period. The study analyzed various parameters, which are: Sex, age, symptoms, size and localization of the tumor, and its gross and histological features. Results: Sclerosing pneumocytoma was more frequently diagnosed in females (83.34%). The patients ranged in age from 38 to 61. Most of the patients (66.66%) were asymptomatic. Two patients underwent a video-assisted thoracoscopic surgery, two patients had a video-assisted minithoracotomy, and two patients underwent a thoracotomy in order to remove the tumor. The tumor was localized in the left lower lobe, in the right upper lobe, and in the right lower lobe in 50%, 33.34%, and 16.66% of patients, respectively. The tumor size ranged from 1 to 2.5 cm. A pathohistological examination of all six cases reported that all four major histological patterns were found in tissue sections: solid, papillary, sclerosing, and hemorrhagic. In all six cases, an immunohistochemical analysis showed positive expression of TTF-1 and panCK in surface epithelial cells, and TTF-1 positivity and panCK negativity in round stromal cells. Conclusions: Sclerosing pneumocytoma is a strictly histological diagnosis supported by clinical and radiological findings and corresponding immunohistochemical methods. Lung pathologists should always keep this tumor in mind, since its spectrum of differential diagnosis is wide, and therefore it can be an important diagnostic pitfall.
Collapse
|
18
|
Dvorakovskaya IV, Novitskaya TA, Mazitova FM, Skryabin SA, Gordeladze AS. [On the histo- and morphogenesis of sclerosing pneumocytoma and its diagnostic criteria]. Arkh Patol 2018; 80:52-57. [PMID: 29460895 DOI: 10.17116/patol201880152-57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper presents the data available in the literature on the pathogenesis, clinical and morphological, histological and immunohistochemical features of pulmonary sclerosing pneumocytoma (SP). The paper gives the detailed histological and immunohistochemical characteristics of 6 SP cases. The need for the differential diagnosis of SP is determined by the features and complexity of their histo- and morphogenesis within a single tumor and a complex diagnostic study.
Collapse
Affiliation(s)
- I V Dvorakovskaya
- Research Institute of Pulmonology, Acad. I.P. Pavlov Saint Petersburg State Medical University, Ministry of Health of the Russian Federation, St. Petersburg, Russia; Saint Petersburg Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - T A Novitskaya
- Saint Petersburg Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, St. Petersburg, Russia; P.A. Bayandin Murmansk Regional Clinical Hospital, Murmansk, Russia
| | - F M Mazitova
- Saint Petersburg Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - S A Skryabin
- P.A. Bayandin Murmansk Regional Clinical Hospital, Murmansk, Russia
| | - A S Gordeladze
- Research Institute of Pulmonology, Acad. I.P. Pavlov Saint Petersburg State Medical University, Ministry of Health of the Russian Federation, St. Petersburg, Russia, Saint Petersburg Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation, St. Petersburg, Russia, P.A. Bayandin Murmansk Regional Clinical Hospital, Murmansk, Russia
| |
Collapse
|
19
|
Fan X, Lin L, Wang J, Wang Y, Feng A, Nie L, Wu H, Meng F, Xu H. Genome profile in a extremely rare case of pulmonary sclerosing pneumocytoma presenting with diffusely-scattered nodules in the right lung. Cancer Biol Ther 2017; 19:13-19. [PMID: 29236566 DOI: 10.1080/15384047.2017.1360443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pulmonary sclerosing pneumocytoma (PSP) typically presents solitary and peripheral mass, while only rarely cases display unusual multiple lesions. We reported a extremely rare case of PSP with diffusely-scattered nodules in the right lung. CASE PRESENTATION Diffusely round-shaped nodular shadows in the right lung were found by CT scan in a 31-year-old Chinese woman. The patient undergone the right pneumnectomy. Grossly, numerous small nodules, up to 2.5 cm in greatest dimension were identified in the upper, middle and lower lobes of the right lung. Histologically, the tumor presented the typical features of PSP, with a variable proportion of solid, sclerotic and papillary patterns. Immunohistochemical staining further revealed that cuboidal surface epithelial cells were positive for TTF-1, EMA, AE1/3 and vimentin (partially), and round or polygonal cells expressed TTF-1, vimentin, EMA (weakly), synaptophysin (partially), progesterone receptor (partially), and estrogen receptor (scatteredly). The patient has been followed up for 83 months after surgery by annual chest CT and no new lesions are detected in her left lung and other organs. The whole-exome sequencing identified 15 somatic mutations genes (MEGF6, DNAH5, AKT1, GPRIN2, PIK3AP1, FBXO40, HERC1, VPS16, MORN1, ZNF474, CTNNB1, ZNF251, TSC1, ATM, KDR). Pathway analysis showed possible pathways like the components of CTNNB1, AKT1, and TSC1 mutations in the PI3K/AKT signalings and AKT1, KDR and ATM in VEGF signaling pathway and AKT1 activation seemed closely related with these pathways. CONCLUSION According to our and previous data, PSP with diffuse or multiple lesions is very rare, and the patients are most commonly seen in women in Asian countries. The misdiagnosis rate by clinical and intraoperative frozen-section assessment is high because of the multiple nodules in the lung and its confusing histological features. Long time follow up indicates surgical resection should not be considered as the preferred strategy for treating multiple PSP in the intralobar sites. AKT1 activation may contribute to the development of PSP while the pathogenesis of diffuse or multiple PSP still needs to be further analyzed.
Collapse
Affiliation(s)
- Xiangshan Fan
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Ling Lin
- b Department of Medicine , Shanghai Biotecan Pharmaceuticals Co., Ltd. , Pudong New District , Shanghai , China
| | - Jianjun Wang
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Yu Wang
- b Department of Medicine , Shanghai Biotecan Pharmaceuticals Co., Ltd. , Pudong New District , Shanghai , China
| | - Anning Feng
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Ling Nie
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Hongyan Wu
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Fanqing Meng
- a Department of Pathology , Nanjing Drum Tower Hospital, the affiliated Hospital of Nanjing University Medical School , Nanjing , Jiangsu Province , China
| | - Haodong Xu
- c Department of Pathology & Laboratory Medicine , David Geffen School of Medicine, UCLA , Los Angeles , California , USA
| |
Collapse
|
20
|
Jiang L, Sun L, Liu L. Benign tumor behaves malignantly: a case report of bilateral multiple pulmonary sclerosing pneumocytoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:8735-8740. [PMID: 31966733 PMCID: PMC6965486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/27/2015] [Indexed: 06/10/2023]
Abstract
A 66 year old was woman admitted to our respiratory department after being diagnosed with intrapulmonary metastasis of lung cancer. For further evaluation, we performed a CT guided percutaneous pulmonary puncture biopsy following the thorax-computed tomography, which revealed multiple nodules in the lung field. Histological analysis suggested that it was pulmonary sclerosing pneumocytoma. It's really hard to distinguish whether a lung lesion is malignant or benign using only a thorax-computed tomography, and an accurate diagnosis leads to the right medical decision-making. Pulmonary sclerosing pneumocytoma (PSP) is a unique, uncommon carcinoid tumor, which dominantly appears among the middle-aged women, especially the Asian women. Only a handful literature has reported PSP with lymph nodes metastasis and multicentric PSP. It has proven that it has the potential to metastasize. That is why this rare case merits our attention when we handle similar situations.
Collapse
Affiliation(s)
- Lisha Jiang
- Ambulatory Surgery Center, Cancer Center, West China Hospital, Sichuan UniversityChengdu 610041, P. R. China
| | - Lu Sun
- Cancer Center, West China Hospital, Sichuan UniversityChengdu 610041, P. R. China
| | - Lei Liu
- Cancer Center, West China Hospital, Sichuan UniversityChengdu 610041, P. R. China
| |
Collapse
|
21
|
Cho HJ, Lee JH, Lee GK, Hong EK, Kim HY. Case of sclerosing pneumocytoma combined with a typical carcinoid and pulmonary adenocarcinoma in different lobes. Thorac Cancer 2017; 8:372-375. [PMID: 28474862 PMCID: PMC5494453 DOI: 10.1111/1759-7714.12449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/26/2017] [Accepted: 03/26/2017] [Indexed: 02/02/2023] Open
Abstract
We report the first case of a 62‐year‐old man with a sclerosing pneumocytoma (SP) combined with a typical carcinoid (TC) and pulmonary adenocarcinoma in different lung lobes. Computed tomography revealed two nodules. The radiological diagnosis was primary lung cancer and a metastatic nodule; however, no enlarged lymph nodes were observed. Histological and immunohistochemical analyses defined the 1.7 cm nodule in the right upper lobe as adenocarcinoma and the 1.3 cm nodule in the left lower lobe as SP combined with TC. This case is noteworthy because of the rarity of SP combined with TC, the comprehensive examination of frozen and permanent sections, and the clinical implications of the differential diagnosis of lung nodules.
Collapse
Affiliation(s)
- Hwa Jin Cho
- Department of Pathology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Ji Hyeon Lee
- Department of Pathology, National Cancer Center, Goyang, South Korea
| | - Geon Kook Lee
- Department of Pathology and Center for Lung Cancer, National Cancer Center, Goyang, South Korea
| | - Eun Kyung Hong
- Department of Pathology and Center for Liver Cancer, National Cancer Center, Goyang, South Korea
| | - Hyae Young Kim
- Department of Radiology and Center for Lung Cancer, National Cancer Center, Goyang, South Korea
| |
Collapse
|
22
|
Santamaria-Barria JA, Sceusi EL, Antonoff MB. Bilateral Pulmonary Pneumocytomas. Semin Thorac Cardiovasc Surg 2017; 29:558-560. [PMID: 29698656 DOI: 10.1053/j.semtcvs.2017.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Juan A Santamaria-Barria
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas.
| | - Eric L Sceusi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
23
|
Whole-exome sequencing identifies recurrent AKT1 mutations in sclerosing hemangioma of lung. Proc Natl Acad Sci U S A 2016; 113:10672-7. [PMID: 27601661 DOI: 10.1073/pnas.1606946113] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pulmonary sclerosing hemangioma (PSH) is a benign tumor with two cell populations (epithelial and stromal cells), for which genomic profiles remain unknown. We conducted exome sequencing of 44 PSHs and identified recurrent somatic mutations of AKT1 (43.2%) and β-catenin (4.5%). We used a second subset of 24 PSHs to confirm the high frequency of AKT1 mutations (overall 31/68, 45.6%; p.E17K, 33.8%) and recurrent β-catenin mutations (overall 3 of 68, 4.4%). Of the PSHs without AKT1 mutations, two exhibited AKT1 copy gain. AKT1 mutations existed in both epithelial and stromal cells. In two separate PSHs from one patient, we observed two different AKT1 mutations, indicating they were not disseminated but independent arising tumors. Because the AKT1 mutations were not found to co-occur with β-catenin mutations (or any other known driver alterations) in any of the PSHs studied, we speculate that this may be the single-most common driver alteration to develop PSHs. Our study revealed genomic differences between PSHs and lung adenocarcinomas, including a high rate of AKT1 mutation in PSHs. These genomic features of PSH identified in the present study provide clues to understanding the biology of PSH and for differential genomic diagnosis of lung tumors.
Collapse
|
24
|
Patrini D, Shukla R, Lawrence D, Borg E, Hayward M, Panagiotopoulos N. Sclerosing hemangioma of the lung showing strong FDG avidity on PET scan: Case report and review of the current literature. Respir Med Case Rep 2016; 17:20-3. [PMID: 27222778 PMCID: PMC4821325 DOI: 10.1016/j.rmcr.2015.12.005] [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: 12/12/2015] [Accepted: 12/17/2015] [Indexed: 11/05/2022] Open
Abstract
Sclerosing Hemangioma is a rare lung tumor with polymorphic histologic features that usually occurs in middle aged women. Based on many immunohistochemical and ultrastructural studies, it is most probably derived from undifferentiated respiratory epithelial cells. Symptoms are usually due to enlargement of the tumor and compression of the surrounding tissues. Occurrence of multiple lesions or metastasis is extremely rare although some authors consider sclerosing hemangioma as a potentially low grade malignancy tumor. It usually presents with low to moderate uptake on FDG PET imaging. We present a case of sclerosing hemangioma with strong FDG avidity on PET scan in a 41 year old lady with history of haemoptysis. A full review of the literature on this topic was performed.
Collapse
Affiliation(s)
- Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London UK
| | - Rajeev Shukla
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London UK
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London UK
| | - Elaine Borg
- Department of Histopathology, University College London Hospitals (UCLH), London UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London UK
| | | |
Collapse
|
25
|
CASO CLÍNICO: HEMANGIOMA ESCLEROSANTE (NEUMOCITOMA) PULMONAR. REVISTA MÉDICA CLÍNICA LAS CONDES 2015. [DOI: 10.1016/j.rmclc.2015.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
26
|
Yamanashi K, Shoji T, Ueda Y, Huang CL. A surgically treated pulmonary sclerosing haemangioma that clinically and radiologically mimicked a thrombosed pulmonary artery aneurysm. BMJ Case Rep 2014; 2014:bcr-2014-206697. [PMID: 25519861 DOI: 10.1136/bcr-2014-206697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 70-year-old woman with a surgically treated pulmonary sclerosing haemangioma that clinically and radiologically mimicked a thrombosed pulmonary artery aneurysm. She underwent intravenous thrombolytic therapy because of acute pulmonary embolism in the bilaterally segmental arteries. The pulmonary embolism had almost disappeared except for a nodular lesion in the middle lobe branch of the pulmonary artery, and a thrombosed pulmonary artery aneurysm with thrombus was suspected in the CT image. The patient underwent a video-assisted thoracoscopic middle lobectomy. The final pathological diagnosis was sclerosing haemangioma. She had experienced no recurrence for 1 year after surgery, and we continue to take great care during her follow-up.
Collapse
Affiliation(s)
- Keiji Yamanashi
- Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tsuyoshi Shoji
- Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Yuichiro Ueda
- Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Cheng-Long Huang
- Respiratory Disease Center, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan
| |
Collapse
|
27
|
Emiralioğlu N, Oğuz B, Akyüz C, Yalçın B, Kiper N, Ersöz DD, Yalçın E, Özçelik U. Successful treatment of pulmonary hemangioma with propranolol. Pediatr Pulmonol 2014; 49:829-33. [PMID: 24574160 DOI: 10.1002/ppul.23008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 01/17/2014] [Indexed: 01/09/2023]
Abstract
Pulmonary hemangioma is a rare benign tumor of the lungs. Airway hemangiomas in particular may lead to feeding difficulties, barking cough, stridor, respiratory distress, and even acute airway obstruction. Hence, such hemangiomas usually require early and aggressive treatment; however, the treatment modalities employed so far have been associated with their own co-morbidities and potential long-term adverse effects for the developing child. Here, we report a case of 9-month-old girl who presented with dyspnea and diagnosed pulmonary hemangioma in the lower lobe of left lung. Propranolol is now used as a first line treatment for infantile hemangiomas by many practitioners so we experienced propranolol treatment. This case report argues the first case of pulmonary hemangioma treated with propranolol successfully.
Collapse
Affiliation(s)
- Nagehan Emiralioğlu
- Department of Pediatrics, Pediatric Pulmonary Medicine Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Wang Y, He Q, Shi W, Wang J, Ji H. A mixture of carcinoid tumors, extensive neuroendocrine proliferation, and multiple pulmonary sclerosing hemangiomas. World J Surg Oncol 2014; 12:209. [PMID: 25022617 PMCID: PMC4110236 DOI: 10.1186/1477-7819-12-209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/04/2014] [Indexed: 01/19/2023] Open
Abstract
We encountered an extremely rare case of multiple pulmonary sclerosing hemangiomas (PSH) with extensive neuroendocrine lesions, including pulmonary neuroendocrine cell (PNC) hyperplasia, multiple carcinoid tumorlets and typical carcinoid tumors within one pulmonary lobe. To the best of our knowledge, this is the first reported case in the English medical literature of PSH combined and admixed with carcinoid tumors and extensive neuroendocrine proliferation. This case is noteworthy for several reasons. First, the lesion is multi-nodular and unusually large for a typical PSH, which may mimic malignancy on imaging studies and cause diagnostic difficulties. Second, sampling bias may lead to diagnostic errors for a lesion containing two different types of neoplasms. Third, our case displays a rare mixed and mosaic pattern of PSH with a full spectrum of pulmonary neuroendocrine lesions, which may imply a potential intrinsic association in pathogenesis between PSH and concomitant neuroendocrine neoplasms. The clinical implication of multiple PSHs is also discussed.
Collapse
Affiliation(s)
- Yihong Wang
- Department of Surgery and Pathology, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, 3# East Qingchun Road, Hangzhou, Zhejiang 310016, China.
| | | | | | | | | |
Collapse
|
29
|
Shin SY, Kim MY, Lee HJ, Oh SY, Jang SJ. Clustered pulmonary sclerosing pneumocytoma in a young man: a case report. Clin Imaging 2014; 38:532-535. [PMID: 24667045 DOI: 10.1016/j.clinimag.2014.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/05/2014] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
Pulmonary sclerosing pneumocytoma is a rare, benign lung tumor that usually occurs in middle-aged women. It usually manifests as isolated pulmonary nodules and is often confused with other solitary, benign nodules. We present a case of sclerosing pneumocytoma with clustered lung nodules and surrounding ground-glass opacity in a single lobe in a young man. Progressive growth was seen on serial computed tomography observations, and the nodules appeared similar to those seen in active pulmonary tuberculosis.
Collapse
Affiliation(s)
- So Youn Shin
- Department of Radiology, Graduate School of Medicine, Kyung Hee University, Hoegi-dong, Dongdaemun-gu, Seoul, 130-701, Korea
| | - Mi Young Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
| | - Hyun Joo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Se Jin Jang
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| |
Collapse
|