Pulmonary sclerosing pneumocytoma - approaching a solitary pulmonary nodule and the limitations of risk prediction models

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.

Increased 68 Ga-FAPI Uptake in Pulmonary Sclerosing Pneumocytoma

ABSTRACT

Pulmonary sclerosing pneumocytoma is a rare benign neoplasm arising from the primitive respiratory epithelium. Here, we report 68 Ga-FAPI PET/CT findings of pulmonary sclerosing pneumocytoma in a 55-year-old woman. The images showed a solitary pulmonary mass in the left lower lobe with intense 68 Ga-FAPI uptake. Our case illustrates that the sclerosing pneumocytoma should be taken into consideration as one of the differential diagnoses in lung nodules/masses with intense 68 Ga-FAPI uptake.

Pulmonary Sclerosing Pneumocytoma on 18 F-FDG PET/MRI

ABSTRACT

Pulmonary sclerosing pneumocytoma is a rare benign neoplasm. Owing to the low incidence, its radiographic features on 18 F-FDG PET/MRI are not well-known. Herein, we described findings of pulmonary sclerosing pneumocytoma on 18 F-FDG PET/MRI in a 52-year-old woman. It showed moderate FDG uptake and hyperintensity signal on both T1WI and T2WI images.

Pulmonary Sclerosing Pneumocytoma: A Pre and Intraoperative Diagnostic Challenge. Report of Two Cases and Review of the Literature

Pulmonary sclerosing pneumocytoma is a rare benign pulmonary tumor of primitive epithelial origin. Because of the unspecific radiological features mimicking malignancies and its histological heterogeneity, the differential diagnosis with adenocarcinoma and carcinoid tumors is still challenging. We report our experience of two cases of sclerosing pneumocytoma, as well as a review of the literature. Immunohistochemical findings showed intense staining of the cuboidal epithelial cells for cytokeratin-pool and TTF-1, with focal positivity for progesterone receptors. Round and spindle cells expressed positivity for vimentin, TTF-1 and focally for the progesterone receptor. Cytologic diagnosis of pulmonary pneumocytoma requires the identification of its dual cell population, made up of abundant stromal cells and fewer surface cells. Since the pre- and intraoperative diagnosis should guide surgical decision making, obtaining a sufficient specimen size to find representative material in the cell block is of paramount importance.

Concomitance of pulmonary spindle cell carcinoma and sclerosing pneumocytoma in a woman: A case report

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.

Pulmonary sclerosing pneumocytoma of the lung: CT characteristics in a large series of a tertiary referral center

The purpose of this study is to describe the detailed clinical, chest computed tomography (CT), and F-fluorodeoxyglucose positron emission tomography (FDG PET) characteristics of the tumor boundary for the diagnosis and investigate the outcome of pulmonary sclerosing pneumocytoma (PSP) using confirmed large data of a tertiary referral center. Confirmed 76 patients were included. We evaluated the findings of CT including 4 CT signs, FDG PET, and histopathology. Most patients had a single lesion (92.1%), smooth boundary (65.8%), and oval shape (65.8%) and the mean diameter was 22.7 mm. The CT signs included marginal pseudocapsule (50%), overlying vessel (26.3%), air gap (2.6%), and halo sign (17.1%). A predominantly solid was the most common histopathologic type. The mean maximum standardized uptake value on FDG PET of 17 patients was 1.8 (range, near 0 or normal tissue metabolism ∼2.9). PSP should be considered in middle-aged women whose CT features show incidental nodule(s), commonly with surrounding ground-glass opacity and characteristic CT signs of the tumor boundary, and hypometabolic uptake on FDG PET. Outcome of patients is excellent.

Bilateral multiple sclerosing hemangiomas of the lung

This report presents a case of bilateral multiple sclerosing hemangiomas of the lung in a 73-year-old woman. A computed tomography (CT) scan of the chest showed a total of three well-defined small nodules in the right and left lower lobes of the lung. Because malignant metastatic lung tumors were highly suspected, a wedge resection of the left lower lobe was performed to obtain a definitive diagnosis. Histopathologically, two tumors of the left lower lobe were composed of epithelial-like cuboidal cells covering the surface of papillary protrusions and sheets of round to polygonal cells underneath the epithelial-like cells. The final diagnosis was that both tumors were sclerosing hemangiomas. After surgery the residual lesion of the right lower lobe was carefully followed by chest CT. The size of the right lung nodule did not change over the course of 9 years, and no new lesion has emerged.

From the Archives of the AFIP: pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis

Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) are two unusual idiopathic disorders that almost uniformly manifest to the clinician as pulmonary arterial hypertension (PAH). Impressive clinical signs and symptoms often obscure the true underlying capillary or postcapillary disorder, thus severely compromising timely and appropriately directed therapy. The hemodynamics of PVOD and PCH are the consequence of a widespread vascular obstructive process that originates in either the alveolar capillary bed (in cases of PCH) or the pulmonary venules and small veins (in PVOD). Since the earliest descriptions of PVOD and PCH, there has been a debate as to whether these are two distinct diseases or varied expressions of a single disorder. The cause of PVOD or PCH has not yet been identified, although there are several reported associations. Without curative lung or heart-lung transplantation, patients with these conditions face inexorable clinical deterioration and death within months to a few short years of initial presentation. Surgical lung biopsy is the definitive diagnostic test, but it is a risky undertaking in such critically ill patients. The imaging manifestations of PVOD and PCH often reflect the underlying hemodynamic derangements, and these findings may assist the clinician in discerning PAH from an underlying capillary or postcapillary process with findings of septal lines, characteristic ground-glass opacities, and occasionally pleural effusion.

Pulmonary sclerosing haemangioma mimicking hydatid cyst: a case report

We report the case of a pulmonary sclerosing haemangioma radiologically presenting as a cystic lesion. The patient was found to have specific anti-echinococcus immunoglobulin E and therefore the preoperative diagnosis was that of pulmonary hydatid cyst. A surgical resection was performed. Although rarely encountered, pulmonary sclerosing haemangioma may show radiological and serological similarities to a pulmonary hydatid cyst. Both entities necessitate complete removal of the lesion without parenchymal resection.

[A case or operative treatment of a rare lung tumor (sclerosing haemangioma)]

Sclerosing hemangioma of the lung is a rare tumor, defined as benign, but it has the propensity for recurrence and metastases. We present a case of operative treatment of a 37-years-old female patient with such tumor, with preoperatively assessed clinical and X-ray evidence for tumor formation in the right lung. At the operation we found a tumor in the third segment of the right lung, resembling visually and histologically (frozen section) a metastase. A wedge resection of the superior lobe was performed. Histological examination (including immunohistochemistry) showed sclerosing hemangioma (papillary pneumocytoma). There were no complications in the postoperative period, two years after the operation the patient is in very good condition, there is no evidence of recurrence or metastases.

Pulmonary sclerosing hemangioma presenting as solitary pulmonary nodule: dynamic CT findings and histopathologic comparisons

OBJECTIVE

The purpose of this study was to describe the dynamic CT findings of pulmonary sclerosing hemangioma presenting as a solitary pulmonary nodule and to compare these findings with histopathologic findings.

CONCLUSION

On dynamic CT, sclerosing hemangioma has strong and rapid enhancement attributed histopathologically to the presence of hemangiomatous or papillary components in the tumor.

[Small sclerosing hemangioma combined with primary lung cancer; report of a case]

A 56-year-old woman underwent a surgery for right breast cancer when she was 51-year-old. In February 2002, computed tomography (CT) was performed as a part of a follow-up study and showed 2 small nodules in the lower lobe of her right lung: one was 10 mm nodule in S9, and another was 5 mm in S6. On a follow-up CT in March 2005, the S9 nodule had enlarged to 19 mm and was looked as ground glass opacity (GGO). We thought it was primary lung cancer. In contrast, the nodule in S6 had not enlarged and it was thought to be benign. In May 2005, right lower lobectomy was performed. The S9 nodule was diagnosed as adenocarcinoma, and the S6 nodule as sclerosing hemangioma.

Multiple sclerosing hemangiomas with a 10-year history

We report a case of multiple sclerosing hemangiomas arising in a 38-year-old woman. Computed tomography (CT) scans of the chest showed multiple small nodules in all lobes of the right lung. The nodule sizes ranged from a few millimeters to the largest of 3.1 cm, which was located in the right middle lobe. She underwent right middle lobectomy to confirm the histological diagnosis. The resected specimen revealed multiple sclerosing hemangiomas. We followed this patient by annual chest CT scans for 10 years and demonstrated that all residual nodules remained unchanged. This is the first report of stable multiple pulmonary sclerosing hemangiomas observed for such a long period.

Multiple sclerosing hemangiomas of the lung

Multifocal sclerosing hemangioma of the lung is a rare entity. While solitary pulmonary lesions by themselves are uncommon and few reports have been described, multifocal bilateral lesions are rare and limited instances have been cited in indexed medical literature. We herewith describe a case of multiple sclerosing hemangiomas of the lung, in a patient who also had a vascular malformation over the calf.

A case of sclerosing hemangioma surrounded by emphysematous change

A 44-year-old woman presented with high-grade fever. Chest radiography showed a 30 mm solitary pulmonary mass in the left lower lobe. Chest CT revealed a well-defined solid mass in the left lower lobe. On contrast-enhanced CT, the mass showed homogeneity and mild enhancement. There was an emphysematous portion in the surrounding lung parenchyma. The patient underwent partial lobectomy of the left lower lobe. The final diagnosis of sclerosing hemangioma with abundant vasculature was confirmed pathologically. Pulmonary sclerosing hemangioma is a rare benign neoplasm. Some cases have been reported in which sclerosing hemangioma is surrounded by air spaces. We suggest that the air spaces around the tumor were formed by not only peritumoral bleeding but also a check-valve effect of the compressed bronchus.