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Hemangioma in a pulmonary hilar lymph node: case report.

Goto T, Akanabe K, Maeshima A, Kato R - World J Surg Oncol (2011)

Bottom Line: Immunohistochemically, the lesion was positive for factor VIII and CD34, leading to a diagnosis of primary hemangioma of the lymph node.To our knowledge, this is the first case reported in the literature of hemangioma in a pulmonary hilar lymph node.Intranodal hemangioma needs to be differentiated from malignant vascular tumors.

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Affiliation: Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. taichiro@1997.jukuin.keio.ac.jp

ABSTRACT

Background: Different types of vascular proliferation may occur in lymph nodes, but hemangiomas in lymph nodes are extremely rare.

Case presentation: A 73-year-old man was found to have a 15-mm nodular shadow in the left lung on computed tomography, and bronchoscopic brush cytology yielded a diagnosis of squamous cell carcinoma. Chest computed tomography showed no evidence of hilar or mediastinal lymphadenopathy. Left lower lobectomy with hilar and mediastinal lymph node dissection was performed. Postoperative histopathological examination revealed squamous cell carcinoma and no lymph node metastasis. On the other hand, a lobar bronchial lymph node presented a small lesion showing the dense proliferation of capillary blood vessels with elastic change. Immunohistochemically, the lesion was positive for factor VIII and CD34, leading to a diagnosis of primary hemangioma of the lymph node.

Conclusion: To our knowledge, this is the first case reported in the literature of hemangioma in a pulmonary hilar lymph node. Intranodal hemangioma needs to be differentiated from malignant vascular tumors.

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Related in: MedlinePlus

Histological findings of a pulmonary hilar lymph node. A, The lymph node exhibits residual nodal tissue and replacement by a vascular tumor (hematoxylin-eosin staining). B, The lesion is composed of well-developed capillaries. Organizing thrombi were identifiable (hematoxylin-eosin staining). C-D, Endothelial cells were positive for factor VIII and CD34 (C, Factor VIII immunostaining; D, CD34 immunostaining).
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Figure 2: Histological findings of a pulmonary hilar lymph node. A, The lymph node exhibits residual nodal tissue and replacement by a vascular tumor (hematoxylin-eosin staining). B, The lesion is composed of well-developed capillaries. Organizing thrombi were identifiable (hematoxylin-eosin staining). C-D, Endothelial cells were positive for factor VIII and CD34 (C, Factor VIII immunostaining; D, CD34 immunostaining).

Mentions: The patient was a 73-year-old man who was on dialysis for chronic renal failure in our hospital. He experienced pain in the left buccal mucosa, and visited the Department of Oral Surgery of our hospital. Biopsy revealed squamous cell carcinoma. Under a diagnosis of buccal mucosal cancer, he underwent arterial injection chemotherapy and radiation therapy in the Department of Oral Surgery. In addition, he was found to have a 15-mm tumor with an irregular margin in the left S9 on chest computed tomography (CT), and was referred to our department (Figure 1A). Bronchoscopic brush cytology led to a diagnosis of squamous cell carcinoma. The lung tumor showed histological features similar to those of the buccal mucosal cancer, but it was clinically diagnosed as a primary cancer because of its morphology on CT and because the buccal mucosal cancer was an early cancer. Chest CT showed no evidence of hilar or mediastinal lymphadenopathy. Under a diagnosis of lung cancer, left lower lobectomy with hilar and mediastinal lymph node dissection was performed. Postoperative histopathological examination revealed squamous cell carcinoma with stratification and keratinization and no lymph node metastasis. Thus, the tumor was diagnosed as pT1aN0M0, stage IA (Figure 1B). On the other hand, a lobar bronchial lymph node presented a lesion showing the dense proliferation of well-formed capillaries (Figure 2A, B). The stroma of the lesion showed small areas of fibrosis (Figure 2A). The lesion was well circumscribed and its borders sharply demarcated from the nodal lymphoid tissue (Figure 2A). There were organizing thrombi in many of the component capillaries (Figure 2B). There was no nuclear atypia and less mitotic activity. Immunohistochemically, the lesion was positive for factor VIII, α-smooth muscle actin and CD34, and negative for D2-40, cytokeratin AE 1/3, and CD68, leading to a diagnosis of primary hemangioma of the lymph node (Figure 2C, D).


Hemangioma in a pulmonary hilar lymph node: case report.

Goto T, Akanabe K, Maeshima A, Kato R - World J Surg Oncol (2011)

Histological findings of a pulmonary hilar lymph node. A, The lymph node exhibits residual nodal tissue and replacement by a vascular tumor (hematoxylin-eosin staining). B, The lesion is composed of well-developed capillaries. Organizing thrombi were identifiable (hematoxylin-eosin staining). C-D, Endothelial cells were positive for factor VIII and CD34 (C, Factor VIII immunostaining; D, CD34 immunostaining).
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC3037908&req=5

Figure 2: Histological findings of a pulmonary hilar lymph node. A, The lymph node exhibits residual nodal tissue and replacement by a vascular tumor (hematoxylin-eosin staining). B, The lesion is composed of well-developed capillaries. Organizing thrombi were identifiable (hematoxylin-eosin staining). C-D, Endothelial cells were positive for factor VIII and CD34 (C, Factor VIII immunostaining; D, CD34 immunostaining).
Mentions: The patient was a 73-year-old man who was on dialysis for chronic renal failure in our hospital. He experienced pain in the left buccal mucosa, and visited the Department of Oral Surgery of our hospital. Biopsy revealed squamous cell carcinoma. Under a diagnosis of buccal mucosal cancer, he underwent arterial injection chemotherapy and radiation therapy in the Department of Oral Surgery. In addition, he was found to have a 15-mm tumor with an irregular margin in the left S9 on chest computed tomography (CT), and was referred to our department (Figure 1A). Bronchoscopic brush cytology led to a diagnosis of squamous cell carcinoma. The lung tumor showed histological features similar to those of the buccal mucosal cancer, but it was clinically diagnosed as a primary cancer because of its morphology on CT and because the buccal mucosal cancer was an early cancer. Chest CT showed no evidence of hilar or mediastinal lymphadenopathy. Under a diagnosis of lung cancer, left lower lobectomy with hilar and mediastinal lymph node dissection was performed. Postoperative histopathological examination revealed squamous cell carcinoma with stratification and keratinization and no lymph node metastasis. Thus, the tumor was diagnosed as pT1aN0M0, stage IA (Figure 1B). On the other hand, a lobar bronchial lymph node presented a lesion showing the dense proliferation of well-formed capillaries (Figure 2A, B). The stroma of the lesion showed small areas of fibrosis (Figure 2A). The lesion was well circumscribed and its borders sharply demarcated from the nodal lymphoid tissue (Figure 2A). There were organizing thrombi in many of the component capillaries (Figure 2B). There was no nuclear atypia and less mitotic activity. Immunohistochemically, the lesion was positive for factor VIII, α-smooth muscle actin and CD34, and negative for D2-40, cytokeratin AE 1/3, and CD68, leading to a diagnosis of primary hemangioma of the lymph node (Figure 2C, D).

Bottom Line: Immunohistochemically, the lesion was positive for factor VIII and CD34, leading to a diagnosis of primary hemangioma of the lymph node.To our knowledge, this is the first case reported in the literature of hemangioma in a pulmonary hilar lymph node.Intranodal hemangioma needs to be differentiated from malignant vascular tumors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. taichiro@1997.jukuin.keio.ac.jp

ABSTRACT

Background: Different types of vascular proliferation may occur in lymph nodes, but hemangiomas in lymph nodes are extremely rare.

Case presentation: A 73-year-old man was found to have a 15-mm nodular shadow in the left lung on computed tomography, and bronchoscopic brush cytology yielded a diagnosis of squamous cell carcinoma. Chest computed tomography showed no evidence of hilar or mediastinal lymphadenopathy. Left lower lobectomy with hilar and mediastinal lymph node dissection was performed. Postoperative histopathological examination revealed squamous cell carcinoma and no lymph node metastasis. On the other hand, a lobar bronchial lymph node presented a small lesion showing the dense proliferation of capillary blood vessels with elastic change. Immunohistochemically, the lesion was positive for factor VIII and CD34, leading to a diagnosis of primary hemangioma of the lymph node.

Conclusion: To our knowledge, this is the first case reported in the literature of hemangioma in a pulmonary hilar lymph node. Intranodal hemangioma needs to be differentiated from malignant vascular tumors.

Show MeSH
Related in: MedlinePlus