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Coexistence of pulmonary sclerosing hemangioma and primary adenocarcinoma in the same nodule of lung.

Liu W, Tian XY, Li Y, Zhao Y, Li B, Li Z - Diagn Pathol (2011)

Bottom Line: Under the microscopy, there was no gradual transition of these two portions observed in mass.A diagnosis of PSH combined with primary adenocarcinoma of lung was made.To our knowledge, this is the first case of coexistence of PSH and adenocarcinoma in the same nodule of lung.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, China.

ABSTRACT
Pulmonary sclerosing hemangiomas (PSH) of the lung are uncommon tumors and may present cytological atypia with unusual manifestations. The development of PSH combined with other different tumors in lung is extremely rare. We report a case of coexistence of PSH and primary adenocarcinoma in a young female occurring in the same pulmonary nodular mass of right lower lobe. The solitary mass of lung was well-circumscribed on chest computed tomography (CT) and gross examination. Histologically, the mass contained two separated portions and displayed typically histological features of PSH and acinar adenocarcinoma, respectively. In PSH portion, the tumor was composed of sheets of round cells with scattered surface cuboidal cells forming small tubules. Both round and surface cells were diffusely positive for epithelial membrane antigen (EMA) and thyroid transcription factor-1 (TTF-1), but lack immunoreactivity for pancytokeratin in round cells. In adenocarcinoma portion, the tumor cells formed irregular-shaped glands with cytologically malignant cells infiltrating in fibroblastic stroma, and no TTF-1-positive round cells could be observed in this portion. Under the microscopy, there was no gradual transition of these two portions observed in mass. A diagnosis of PSH combined with primary adenocarcinoma of lung was made. There was no evidence of tumor recurrence during the period of postoperative 6-month follow-up. To our knowledge, this is the first case of coexistence of PSH and adenocarcinoma in the same nodule of lung. In addition, the biological behavior and histological differential diagnosis of this tumor were also discussed.

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Preoperative chest radiology of lesion. (a) Chest X-ray revealed solitary pulmonary mass in right lower lung field (black arrow). (b) Chest CT image showed well-defined mass in right lower lobe (white arrow). There was no remarkable image finding was noted in the surrounding lung parenchyma.
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Figure 1: Preoperative chest radiology of lesion. (a) Chest X-ray revealed solitary pulmonary mass in right lower lung field (black arrow). (b) Chest CT image showed well-defined mass in right lower lobe (white arrow). There was no remarkable image finding was noted in the surrounding lung parenchyma.

Mentions: A 22-year-old woman with a 4-month history of pulmonary mass was admitted to our hospital for further examination and treatment. The pulmonary mass was first detected on chest radiography when she underwent annual body examination at a local hospital (Figure 1A). For unknown reasons, the patient failed to receive workup and management at that time. On admission in our hospital, physical examination and routine laboratory test was no positive finding. Sputum examination showed no pathogenic organisms and malignant cells. Chest computed tomography (CT) revealed a well-defined 2.5 cm mass with CT attenuation value of 35 HU was located in the right lower lobe of lung. Contrast-enhanced CT was not performed. Neither enlarged lymph node nor remarkable image finding was noted in the surrounding lung parenchyma (Figure 1B). According to the recommendation of CT examination, the patient underwent fiberoptic bronchoscopy and transbronchial biopsy, but there was no definitive diagnosis obtained by histological examination. A preoperative presumed diagnosis was PSH and inflammatory pseudotumor of lung. A partial segmentextomy of the right lower lobe was performed, and macroscopical examination revealed a gray-red solitary nodular mass, measuring 2.7 × 2.5 cm, located in the lung parechyma. The mass was well-circumscribed, but there was no fibrous capsule around the mass (Figure 2).


Coexistence of pulmonary sclerosing hemangioma and primary adenocarcinoma in the same nodule of lung.

Liu W, Tian XY, Li Y, Zhao Y, Li B, Li Z - Diagn Pathol (2011)

Preoperative chest radiology of lesion. (a) Chest X-ray revealed solitary pulmonary mass in right lower lung field (black arrow). (b) Chest CT image showed well-defined mass in right lower lobe (white arrow). There was no remarkable image finding was noted in the surrounding lung parenchyma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117760&req=5

Figure 1: Preoperative chest radiology of lesion. (a) Chest X-ray revealed solitary pulmonary mass in right lower lung field (black arrow). (b) Chest CT image showed well-defined mass in right lower lobe (white arrow). There was no remarkable image finding was noted in the surrounding lung parenchyma.
Mentions: A 22-year-old woman with a 4-month history of pulmonary mass was admitted to our hospital for further examination and treatment. The pulmonary mass was first detected on chest radiography when she underwent annual body examination at a local hospital (Figure 1A). For unknown reasons, the patient failed to receive workup and management at that time. On admission in our hospital, physical examination and routine laboratory test was no positive finding. Sputum examination showed no pathogenic organisms and malignant cells. Chest computed tomography (CT) revealed a well-defined 2.5 cm mass with CT attenuation value of 35 HU was located in the right lower lobe of lung. Contrast-enhanced CT was not performed. Neither enlarged lymph node nor remarkable image finding was noted in the surrounding lung parenchyma (Figure 1B). According to the recommendation of CT examination, the patient underwent fiberoptic bronchoscopy and transbronchial biopsy, but there was no definitive diagnosis obtained by histological examination. A preoperative presumed diagnosis was PSH and inflammatory pseudotumor of lung. A partial segmentextomy of the right lower lobe was performed, and macroscopical examination revealed a gray-red solitary nodular mass, measuring 2.7 × 2.5 cm, located in the lung parechyma. The mass was well-circumscribed, but there was no fibrous capsule around the mass (Figure 2).

Bottom Line: Under the microscopy, there was no gradual transition of these two portions observed in mass.A diagnosis of PSH combined with primary adenocarcinoma of lung was made.To our knowledge, this is the first case of coexistence of PSH and adenocarcinoma in the same nodule of lung.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, China.

ABSTRACT
Pulmonary sclerosing hemangiomas (PSH) of the lung are uncommon tumors and may present cytological atypia with unusual manifestations. The development of PSH combined with other different tumors in lung is extremely rare. We report a case of coexistence of PSH and primary adenocarcinoma in a young female occurring in the same pulmonary nodular mass of right lower lobe. The solitary mass of lung was well-circumscribed on chest computed tomography (CT) and gross examination. Histologically, the mass contained two separated portions and displayed typically histological features of PSH and acinar adenocarcinoma, respectively. In PSH portion, the tumor was composed of sheets of round cells with scattered surface cuboidal cells forming small tubules. Both round and surface cells were diffusely positive for epithelial membrane antigen (EMA) and thyroid transcription factor-1 (TTF-1), but lack immunoreactivity for pancytokeratin in round cells. In adenocarcinoma portion, the tumor cells formed irregular-shaped glands with cytologically malignant cells infiltrating in fibroblastic stroma, and no TTF-1-positive round cells could be observed in this portion. Under the microscopy, there was no gradual transition of these two portions observed in mass. A diagnosis of PSH combined with primary adenocarcinoma of lung was made. There was no evidence of tumor recurrence during the period of postoperative 6-month follow-up. To our knowledge, this is the first case of coexistence of PSH and adenocarcinoma in the same nodule of lung. In addition, the biological behavior and histological differential diagnosis of this tumor were also discussed.

Show MeSH
Related in: MedlinePlus