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Shang Z, Xiang C, Ding B, Zhu Q, Yu M, Han Y. Single-cell transcriptome analysis reveals two subtypes of tumor cells of sclerosing pneumocytoma with distinct molecular features and clinical implications. Mod Pathol 2024:100560. [PMID: 38972356 DOI: 10.1016/j.modpat.2024.100560] [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: 11/27/2023] [Revised: 05/24/2024] [Accepted: 06/26/2024] [Indexed: 07/09/2024]
Abstract
Pulmonary sclerosing pneumocytoma (PSP) is a rare, distinctive benign lung adenoma of pneumocyte origin. Despite its rarity, the tumor's unique cellular morphology has sparked ongoing debates regarding the origin of its constituent cells. This study aimed to elucidate the molecular features of PSP tumor cells and enhance our understanding of the cellular processes contributing to PSP formation and biological behavior. Tissue samples from PSP and corresponding normal lung tissues (n = 4) were collected. We employed single-cell RNA sequencing and microarray-based spatial transcriptomic analyses to identify cell types and investigate their transcriptomes, with a focus on transcription factors, enriched gene expression, and single-cell trajectory evaluations. Our analysis identified two types of tumor cells: mesenchymal epithelial dual phenotype cells (MEDPs) and a distinct subpopulation of type II alveolar epithelial cells exhibiting characteristics slightly reminiscent of type I alveolar epithelial cells (AT2Cs), corresponding to histological round stromal cells and surface cuboidal cells, respectively. MEDPs displayed weak alveolar epithelial differentiation but strong collagen production capabilities, as indicated by the expression of both TTF-1 and vimentin. These cells played a pivotal role in forming the solid and sclerotic areas of PSP. Moreover, MEDPs exhibited a pronounced propensity for epithelial-mesenchymal transition, suggesting a greater potential for metastasis compared to AT2Cs. The capillary endothelial cells of PSP displayed notable diversity. Overall, this study provides, for the first time, a comprehensive mapping of the single-cell transcriptome profile of PSP. Our findings delineate two distinct subtypes of tumor cells, MEDPs and AT2Cs, each with its own biological characteristics and spatial distribution. A deeper understanding of these cell types promises insights into the histology and biological behaviors of this rare tumor.
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Affiliation(s)
- Zhanxian Shang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chan Xiang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bowen Ding
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Yu
- Sheng Yushou Center of Cell Biology and Immunology, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Zenezan D, Yin J, Dioufa N, Firde K, Mollaee M, Akhtar I. Navigating the diagnostic maze: the challenge of sclerosing pneumocytoma in frozen sections. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2024; 17:182-188. [PMID: 39005235 PMCID: PMC11236615 DOI: 10.62347/klwt4935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/27/2024] [Indexed: 07/16/2024]
Abstract
Pulmonary Sclerosing Pneumocytoma (PSP) represents a rare benign tumor that exhibits a predisposition towards females. Often asymptomatic, its identification usually occurs incidentally through imaging modalities. Histologically, PSP demonstrates features consistent with pneumocytic differentiation and possesses a dual-cell population. However, in rare instances it may demonstrate pleural invasion or lymph node metastasis. Diagnosing PSP through small biopsy or frozen section presents considerable challenges attributed to its heterogeneous growth patterns and striking similarity to well-differentiated pulmonary adenocarcinoma. We report a case of PSP in a 57-year-old female smoker, presenting as a slow-growing 2.5 cm mass that recently exhibited enlargement, as noted on computed tomography (CT) scan. The recommendation for excising the mass prompted the patient to undergo a right robotic-assisted thoracoscopic procedure, which entailed wedge resection of the right lower lobe and an intraoperative consultation. A completion right lower lobectomy was performed, accompanied by lymph node dissection, following a frozen section diagnosis indicating at least adenocarcinoma in situ. The permanent section revealed bland cuboidal cells lining papillary and sclerotic areas, with occasional atypical features such as prominent nucleoli and scattered mitotic figures. Adjacent foci of atypical adenomatous hyperplasia (AAH) were noted. Immunohistochemical (IHC) staining revealed positive Napsin A, keratin AE1/3, and CK7 in surface cells but not in round cells. Both EMA and TTF1 immunostains highlighted surface cells and scattered round cells. Elastic stain highlighted visceral pleural involvement. The combined morphology and immunoprofile supported the diagnosis of PSP. This case underscores the critical importance of accurately diagnosing slow-growing pulmonary nodules, which are increasingly detected by the widespread use of imaging for various medical conditions.
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Affiliation(s)
- Dina Zenezan
- Department of Pathology and Laboratory Medicine, Temple University Hospital Philadelphia, PA, USA
| | - Jiejing Yin
- Department of Pathology and Laboratory Medicine, Temple University Hospital Philadelphia, PA, USA
| | - Nikolina Dioufa
- Department of Pathology and Laboratory Medicine, Temple University Hospital Philadelphia, PA, USA
| | - Kassaye Firde
- Department of Pathology and Laboratory Medicine, Temple University Hospital Philadelphia, PA, USA
| | - Mehri Mollaee
- Department of Pathology and Laboratory Medicine, Temple University Hospital Philadelphia, PA, USA
| | - Israh Akhtar
- Department of Pathology and Laboratory Medicine, Temple University Hospital Philadelphia, PA, USA
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Ma T, Tian W, Zhang J, Zhao X. Multiple pulmonary sclerosing pneumocytomas mimicking lung metastasis on 18F-FDG PET/CT: A rare case. Asian J Surg 2024:S1015-9584(24)01043-1. [PMID: 38821821 DOI: 10.1016/j.asjsur.2024.05.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/16/2024] [Indexed: 06/02/2024] Open
Affiliation(s)
- Tuo Ma
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Weiwei Tian
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Jingmian Zhang
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China.
| | - Xinming Zhao
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China; Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China.
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Saripalli KR, Wang MQW, Chow CY, Chew SY. Pulmonary sclerosing pneumocytoma - approaching a solitary pulmonary nodule and the limitations of risk prediction models. BMJ Case Rep 2023; 16:e257208. [PMID: 37977835 PMCID: PMC10660428 DOI: 10.1136/bcr-2023-257208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Our case is an asymptomatic, non-smoking, East Asian woman in her 40s presenting with a solitary pulmonary nodule (SPN). On imaging, the 1.7 cm solid SPN located in the left upper lobe, was rounded in morphology and moderately fluorodeoxyglucose avid. The clinical pretest probability of malignancy assessed by risk prediction models such as Brock (19.1%), Mayo Clinic (56.2%) and Herder (51.4%) was discordant. She underwent a percutaneous CT-guided needle biopsy, establishing a diagnosis of pulmonary sclerosing pneumocytoma (PSP). PSP is a rare benign lung neoplasm with indolent growth characteristics that has been described predominantly in non-smoking women. Our case illustrates the limitations of applying existing risk prediction models in Asia where the epidemiology and biology of lung cancer differ significantly from the Caucasian derivation cohorts. Additionally, the risk models do not account for tuberculosis, which is endemic in Asia and can mimic malignancy. Non-surgical lung biopsy remains useful in minimising unnecessary thoracotomy.
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Affiliation(s)
| | - Mark Qi Wei Wang
- Department of Vascular and Interventional Radiology, SingHealth Group, Singapore
| | - Chun Yuen Chow
- Department of Anatomical Pathology, SingHealth Group, Singapore
| | - Si Yuan Chew
- Department of Respiratory and Critical Care Medicine, SingHealth Group, Singapore
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Zhang WD, Shi ZE, Zhang MY, Yin YH, Li H, Qu YQ. Giant pulmonary sclerosing pneumocytoma with potentially malignant biological behavior: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:365. [PMID: 37675291 PMCID: PMC10477650 DOI: 10.21037/atm-22-4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/17/2023] [Indexed: 09/08/2023]
Abstract
Background Pulmonary sclerosing pneumocytoma (PSP) is a rare benign lung tumor which generally presents as a solitary pulmonary nodule in middle-aged females. However, the PSP in some patients exhibits potentially malignant biological behavior, with recurrence and lymphatic or distant metastasis being observed. Case Description We encountered a case of a 46-year-old female with an inordinately massive tumor 9.5 cm in diameter and a relatively high Ki-67 proliferation rate. Fine needle aspiration (FNA) played a significant but limited role in the preoperative diagnosis: the computed tomography (CT)-guided lung puncture biopsy was consistent with the typical pathology of PSP; however, endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) could not provide a definitive diagnosis. The patient ultimately underwent thoracoscopic resection and mediastinal lymph node dissection. Here, we provide a review of the literature on patients with PSP with malignant biological behavior to raise awareness of the malignant potential of PSP and describe our experience to inform future management. Conclusions PSP lacks specificity in its clinical and radiological characteristics and has complex pathological manifestations. FNA is valuable in the diagnosis and differential diagnosis of PSP but involves the risk of misdiagnosis or missed diagnosis. Additionally, we believe that the accepted benign features of PSP need to be updated and that the potential malignant features of PSP should be carefully monitored. Surgical resection is curative but strict follow-up is crucial.
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Affiliation(s)
- Wen-Di Zhang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Infectious Respiratory Diseases, Jinan, China
| | - Zhuang-E Shi
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Infectious Respiratory Diseases, Jinan, China
| | - Meng-Yu Zhang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Infectious Respiratory Diseases, Jinan, China
| | - Yun-Hong Yin
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Shandong Key Laboratory of Infectious Respiratory Diseases, Jinan, China
| | - Hao Li
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Shandong Key Laboratory of Infectious Respiratory Diseases, Jinan, China
| | - Yi-Qing Qu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Shandong Key Laboratory of Infectious Respiratory Diseases, Jinan, China
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LI H, XUE J, LI P, XU Y, ZHENG Z, LI S, LIANG N. [Recent Advances and Controversies in Minute Pulmonary Meningothelial-like Nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2023; 26:621-629. [PMID: 37752542 PMCID: PMC10558766 DOI: 10.3779/j.issn.1009-3419.2023.102.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Indexed: 09/28/2023]
Abstract
Minute pulmonary meningothelial-like nodules (MPMNs) are benign small lesions in the lungs, with similar pathological characteristics to the meningeal epithelium. MPMNs have similar imaging manifestations to malignant tumors, which can lead to misdiagnosis in clinical practice. There is no consensus on the pathogenesis of MPMNs, with some suggest that MPMNs derive from reactive proliferation, while others suggest that MPMNs share a common origin and molecular mechanism with meningiomas in the central nervous system. Understanding the characteristics of MPMNs and studying their pathogenesis will help improve the understanding and diagnosis of MPMNs. In this article, we reviewed the clinical, pathological, imaging characteristics, differential diagnosis and pathogenesis of MPMNs. We also analyze the existing research advances regarding the pathogenesis and propose prospects for further research.
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Xu Y, Li Q, Wang C, Yang X. Pulmonary sclerosing pneumocytoma. Asian J Surg 2023:S1015-9584(23)00391-3. [PMID: 36977616 DOI: 10.1016/j.asjsur.2023.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 03/28/2023] Open
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Ma L, Peterson EA, Shin IJ, Muesse J, Marino K, Steliga MA, Atiq O, Arnaoutakis K, Wardell C, Wooldridge J, Prior F, Johann DJ. An advanced molecular medicine case report of a rare human tumor using genomics, pathomics, and radiomics. Front Genet 2023; 13:987175. [PMID: 36846293 PMCID: PMC9951004 DOI: 10.3389/fgene.2022.987175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/01/2022] [Indexed: 02/12/2023] Open
Abstract
Background: Pulmonary Sclerosing Pneumocytoma (PSP) is a rare tumor of the lung with a low malignant potential that primarily affects females. Initial studies of PSP focused primarily on analyzing features uncovered using conventional X-ray or CT imaging. In recent years, because of the widespread use of next-generation sequencing (NGS), the study of PSP at the molecular-level has emerged. Methods: Analytical approaches involving genomics, radiomics, and pathomics were performed. Genomics studies involved both DNA and RNA analyses. DNA analyses included the patient's tumor and germline tissues and involved targeted panel sequencing and copy number analyses. RNA analyses included tumor and adjacent normal tissues and involved studies covering expressed mutations, differential gene expression, gene fusions and molecular pathways. Radiomics approaches were utilized on clinical imaging studies and pathomics techniques were applied to tumor whole slide images. Results: A comprehensive molecular profiling endeavor involving over 50 genomic analyses corresponding to 16 sequencing datasets of this rare neoplasm of the lung were generated along with detailed radiomic and pathomic analyses to reveal insights into the etiology and molecular behavior of the patient's tumor. Driving mutations (AKT1) and compromised tumor suppression pathways (TP53) were revealed. To ensure the accuracy and reproducibility of this study, a software infrastructure and methodology known as NPARS, which encapsulates NGS and associated data, open-source software libraries and tools including versions, and reporting features for large and complex genomic studies was used. Conclusion: Moving beyond descriptive analyses towards more functional understandings of tumor etiology, behavior, and improved therapeutic predictability requires a spectrum of quantitative molecular medicine approaches and integrations. To-date this is the most comprehensive study of a patient with PSP, which is a rare tumor of the lung. Detailed radiomic, pathomic and genomic molecular profiling approaches were performed to reveal insights regarding the etiology and molecular behavior. In the event of recurrence, a rational therapy plan is proposed based on the uncovered molecular findings.
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Affiliation(s)
- Li Ma
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Department of Information Science, University of Arkansas at Little Rock, Little Rock, AR, United States
| | - Erich A. Peterson
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Ik Jae Shin
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jason Muesse
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Katy Marino
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mathew A. Steliga
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Omar Atiq
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Konstantinos Arnaoutakis
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Christopher Wardell
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jacob Wooldridge
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Donald J. Johann
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States,Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States,*Correspondence: Donald J. Johann,
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Treatment and post-operative follow-up of pulmonary sclerosing pneumocytoma: A case report. Ann Med Surg (Lond) 2022; 84:104836. [PMID: 36582872 PMCID: PMC9793125 DOI: 10.1016/j.amsu.2022.104836] [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: 08/18/2022] [Revised: 09/22/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction and importance Pulmonary sclerosing pneumocytoma (PSP) is a rare tumor thought to originate from respiratory epithelial cells. It is usually benign, but may rarely metastasize to lymph nodes. Surgeons face unique challenges in diagnosis and management of this condition, and ideal surgical management is yet to be established. Case presentation 48-year-old woman with a 7 × 7 mm pulmonary lesion discovered incidentally on computerized tomography (CT) imaging, which grew to 9 mm over the following year. Seven years later, follow-up imaging revealed that the mass had grown to 1.3 cm in largest dimension. Surgery was recommended and the mass was resected via a right video-assisted thoracic surgery (VATS) middle lobectomy with mediastinal lymph node dissection. All lymph nodes were negative and the patient's postoperative course was unremarkable. Clinical discussion There are few evidence-based guidelines available on the treatment and postoperative surveillance of PSP. Research has shown comparable recurrence-free survival rates for sublobar resection and lobectomy, though recurrence can occur, especially following sublobar resection in larger or more centrally-located tumors. In absence of established guidelines, it was decided to follow this patient according to NCCN guidelines for surveillance of early-stage non-small cell lung cancer due to potential risk of recurrence. Conclusion This case report adds to the limited literature on PSP and depicts a possible treatment and postoperative follow-up plan. Right VATS middle lobectomy can effectively treat some cases of central PSP. In absence of established guidelines for postoperative follow-up of PSP, NCCN guidelines may outline one possible strategy for postoperative management.
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