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Toro Soto PA, Rivero de Jesús É, Arenas Jiménez J, Aranda López FI. Sclerosing pneumocytoma with carcinoid tumorlets and neuroendocrine cell hyperplasia. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2022; 55 Suppl 1:S44-S48. [PMID: 36075662 DOI: 10.1016/j.patol.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/06/2020] [Accepted: 02/24/2020] [Indexed: 06/15/2023]
Abstract
Sclerosing pneumocytoma is an uncommon pulmonary tumor which generally behaves benignly and occurs predominately in women. Rarely, it is associated with neuroendocrine proliferations such as hyperplasia, tumorlets and carcinoid tumors, which may be observed in relation to the tumor or in the distant lung parenchyma; the mechanism underlying this neuroendocrine differentiation is not clear. We present a case of a 33 year-old male with sclerosing pnemocytoma with coexistent neuroendocrine hyperplasia and combined carcinoid tumorlets. Taking into account the pluripotentiality of the round cells present in the sclerosing pneumocytoma, with positive staining for stem cells markers, it is possible that the different components of this neoplasia share a common origin, in accordance with previously reported findings.
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Sclerosing Pneumocytoma: A Host for a Typical Carcinoid With Pleural Metastasis-A Wolf in Sheep`s Clothing. Chest 2021; 159:e1-e5. [PMID: 33422233 DOI: 10.1016/j.chest.2020.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/25/2020] [Accepted: 06/25/2020] [Indexed: 12/27/2022] Open
Abstract
Sclerosing pneumocytoma (SP) is a rare primary lung tumor. Typical carcinoids (TCs) count for 2% of lung malignancies. A description of a combined neoplasm of SP with a nodal and pleural metastasized TC has, to our knowledge, never been published. A 57-year-old actively smoking woman received a diagnosis of a lesion in the left lower lobe via a screening CT scan for rheumatoid arthritis. A fluorodeoxyglucose-PET scan confirmed a 21 × 26 × 16 mm (standardized uptake maximum value, 3.0), well-circumscribed round lesion with calcification, which was thought to be most probably benign. No mediastinal lymph node enlargement or fluorodeoxyglucose uptake was detected. The results of routine laboratory tests, respiratory function tests, and physical examination were unremarkable. In diagnostic thoracoscopy pleural, diaphragmatic, and pericardial lesions were discovered and biopsied in addition to a wedge resection. After diagnosis of a pleural metastasized TC mixed with SP, radical resection and systemic lymph node dissection were performed. The patient is in remission after 36 months of follow-up.
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Cai L, Wang T, Jiang L, Yang P, Hu J, Jiang J. Sclerosing pneumocytoma mixed with a columnar clear cell adenoma and a typical carcinoid: case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2599-2607. [PMID: 33165428 PMCID: PMC7642712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
Sclerosing pneumocytoma (SP) is a rare and benign tumor predominantly occurring in Asian women, easily misdiagnosed by imaging and pathologic frozen diagnosis during surgery because of its diverse histomorphology (4 structures, 2 types of cells). It may form multiple tumors. When SP is combined with carcinoid, adenoma, or other tumors (although rare), diagnosis is more complicated. SP mixed with carcinoid tumor is rare. At present, only 4 cases have been reported in English literature. Here, we report a case of sclerosing pneumocytoma combined not only with carcinoid, but also with clear cell adenoma of the lung. The patient was a 52-year-old female and CT found a nodule in the middle lobe of the right lung. SP was not excluded by intraoperative frozen section diagnosis. The above 3 components formed a 1.4 cm nodule. The related literature is reviewed to strengthen the understanding of SP, and aid clinicopathological diagnosis.
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Affiliation(s)
- Li Cai
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Ting Wang
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Lei Jiang
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Ping Yang
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Jinchen Hu
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
| | - Jing Jiang
- Department of Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University No. 20 East Yuhuangding Road, Yantai, Shandong, China
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Han XY, Wang YY, Wei HQ, Yang GZ, Wang J, Jia YZ, Ao WQ. Multifocal neuroendocrine cell hyperplasia accompanied by tumorlet formation and pulmonary sclerosing pneumocytoma: A case report. World J Clin Cases 2020; 8:3583-3590. [PMID: 32913868 PMCID: PMC7457093 DOI: 10.12998/wjcc.v8.i16.3583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary tumorlets are nodular hyperplastic neuroendocrine cells (NECs) that extend beyond the basement membrane. They often coexist with other lung diseases such as fibrosis and bronchiectasis, but rarely accompanied by pulmonary sclerosing pneumocytoma (PSP), which has not been reported in the literature.
CASE SUMMARY A 54-year-old woman was admitted to the hospital because she had symptoms of bloody sputum for more than 4 mo and hemoptysis for 1 wk. Computed tomography images showed atrophy accompanied by infections in the middle lobe of her right lung. Moreover, numerous nodules were identified in the middle lobe of the right lung. The patient underwent thoracoscopic pneumonectomy of the middle lobe of the right lung, and the resected mass was pathologically confirmed to have bronchiectasis, multifocal NEC hyperplasia accompanied by tumorlet, and PSP.
CONCLUSION Our report presents a rare clinical case of bronchiectasis complicated with multifocal NEC hyperplasia, tumorlet, and PSP.
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Affiliation(s)
- Xiao-Yu Han
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Yuan-Yuan Wang
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Hong-Quan Wei
- Department of Pathology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Guang-Zhao Yang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Yu-Zhu Jia
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Wei-Qun Ao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
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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.
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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
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Filosso PL, Ferolla P, Guerrera F, Ruffini E, Travis WD, Rossi G, Lausi PO, Oliaro A. Multidisciplinary management of advanced lung neuroendocrine tumors. J Thorac Dis 2015; 7:S163-71. [PMID: 25984363 DOI: 10.3978/j.issn.2072-1439.2015.04.20] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/17/2015] [Indexed: 01/17/2023]
Abstract
The optimal clinical management of aggressive/advanced lung neuroendocrine tumors (NETs) is still debated, due to their rarity and the lack of prospective randomized studies. Results derive from retrospective mono-Institutional series, and few dedicated prospective trials, recently designed, are still ongoing. In low-grade tumors [bronchial carcinoids (BCs)] surgery, whenever feasible, remains the mainstay of treatment, and chemo/radiotherapy (RT) should be reserved to progressive diseases (PD). In case of resected N1-N2 BCs, a "watch and see" policy associated with a close clinical/radiological follow-up is recommended. Somatostatin analogs (SSA) seem to be effective in controlling BCs associated endocrine syndromes, while SSA antiproliferative effect has also been reported in the past. Targeted therapy with new drugs (Everolimus) seems to be very promising, but further trials are needed. Surgery alone is not sufficient to treat high-grade NETs: adjuvant CT is required also in early stages. Platinum-Etoposide regimen demonstrated to be the most effective; irinotecan and other biological drugs are considered very promising. In conclusion, the management of advanced lung NETs should be individualized by multidisciplinary teams which include Medical and Radiation Oncologists, Surgeons, Pathologists, Pulmonologists, Endocrinologists, Interventional Radiologists, and the prognosis is mainly dependent on tumor grade and its anatomical extent.
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Affiliation(s)
- Pier Luigi Filosso
- 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee
| | - Piero Ferolla
- 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee
| | - Francesco Guerrera
- 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee
| | - Enrico Ruffini
- 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee
| | - William D Travis
- 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee
| | - Giulio Rossi
- 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee
| | - Paolo Olivo Lausi
- 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee
| | - Alberto Oliaro
- 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee
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Automated quantification of Ki-67 proliferative index of excised neuroendocrine tumors of the lung. Diagn Pathol 2014; 9:174. [PMID: 25318848 PMCID: PMC4201714 DOI: 10.1186/s13000-014-0174-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/23/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The histopathologic distinction between typical carcinoid (TC) and atypical carcinoid (AC) of the lung is based largely on mitotic index. Ki-67 may aid in separation of these tumors, as well as the distinction from large cell neuroendocrine carcinoma (LCNEC). METHODS We identified 55 surgically resected primary neuroendocrine lung tumors (39 TC, 7 AC, 9 LCNEC) based on mitotic rate and histologic features. Ki-67 proliferative index based on automated image analysis, tumor necrosis, nodal metastases, local or distant recurrence, and survival were compared across groups. RESULTS The mean mitotic count and Ki-67 index for TC, AC, and LCNEC were 0.1 and 2.3%, 3.4 and 16.8%, and 56.1 and 81.3% respectively. The Ki-67 index did not overlap among groups, with ranges of 0-6.7% for TC, 9.9-25.7% for AC, and 63.2-91.9% for LCNEC. Nodal metastases were identified in 4/39 (10%) TC, 2/7 (22%) AC, and 2/8 (25%) LCNEC. There was no survival difference between TC and AC, but there was a significant survival difference between LCNEC and TC and AC combined (p<0.001). There was a step-wise increase in disease free survival with tumor grade: no TC recurred, 2/7 AC recurred or progressed (median interval 35.5 months), and all LCNEC recurred or progressed (median interval 10.1 months). No patient with TC or AC died of disease, compared to 7/8 LCNEC with follow-up data. CONCLUSIONS We conclude that Ki-67 index is a useful diagnostic marker for neuroendocrine tumors, with 7% a divider between AC and TC, and 50% a divider between LCNEC and AC. LCNEC is biologically different from AC and TC, with a much more aggressive course, and a high Ki-67 index. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_174.
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Tatci E, Ozmen O, Gokcek A, Biner IU, Ozaydin E, Kaya S, Arslan N. 18F-FDG PET/CT rarely provides additional information other than primary tumor detection in patients with pulmonary carcinoid tumors. Ann Thorac Med 2014; 9:227-31. [PMID: 25276242 PMCID: PMC4166070 DOI: 10.4103/1817-1737.140134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/12/2014] [Indexed: 11/04/2022] Open
Abstract
AIM The purpose of this study was to assess the contribution of (18)F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) in detection and staging of pulmonary carcinoid tumors. METHODS A total of 22 patients with pulmonary carcinoid tumors (14 typical, 8 atypical) were reviewed in this retrospective study. PET/CT images of all patients were evaluated for primary tumor as well as metastatic regional lymph nodes, bone and other distant metastases. PET/CT positivity of primary tumors was determined by visual interpretation. Tumor size, SUVmax and Hounsfield Unit (HU) values of the tumors were used to test for differences between tumor groups (typical carcinoids and atypical carcinoids). RESULTS SUVmax of carcinoids ranged from 1.24 to 11.1 (mean, 5.0; median, 2.67). The mean largest diameter of primary tumors was 2.7 ± 1.3 cm, ranging from 1 to 5.5 cm. The overall sensitivity of FDG PET/CT for detection of pulmonary carcinoid tumors was 81.8%. Tumor size, SUVmax and Hounsfield Unit (HU) values of the atypical carcinoids were higher than those for typical carcinoids. However, the results were not statistically meaningful (P > 0.05). The sensitivity and specificity of FDG PET/CT in the detection of mediastinal and hilar lymph nodes metastases were 25% and 83% respectively. One patient had bone metastasis. CONCLUSION Although FDG PET/CT can be a useful tool for the detection of pulmonary carcinoid tumors and distant metastasis, it cannot discriminate typical carcinoids from atypical ones and absence of an FDG avid lesion cannot exclude pulmonary carcinoid tumors. Moreover, PET/CT is not a reliable tool in the staging of mediastinal and hilar lymph nodes especially for those patients with typical carcinoids.
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Affiliation(s)
- Ebru Tatci
- Department of Nuclear Medicine, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ozlem Ozmen
- Department of Nuclear Medicine, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Atila Gokcek
- Department of Radiology, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Inci Uslu Biner
- Department of Nuclear Medicine, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Esra Ozaydin
- Department of Pathology, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Sadi Kaya
- Department of Thoracic Surgery, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Nuri Arslan
- Department of Nuclear Medicine, Gulhane Military Medical Academy and Medical Faculty, Ankara, Turkey
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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.
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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.
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