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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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Postoperative photomicrographs of lesion in PSH portion. (a) the tumor was composed of sheets of round cells with scattered surface cuboidal cells forming small tubules. (b) The surface cuboidal cells demonstrated vacuolated and foamy cytoplasm with focal mild nuclear atypia (black arrow). The round cells showed uniform, medium-size polygonal nuclei with moderate amounts of pale, eosinophilic or clear cytoplasm (black arrowhead). (c) In some area, papillary pattern with hyalinizing stalks could be obsreved. Both surface cuboidal cells and round cells could be found in this structure. (d) Immunohistochemically, positivity of surface cuboidal cells, but negativity of round cells for pancytokeratin was found in tumor. (e) Both surface (black arrow) and round cells (black arrowhead) showed strongly positive for TTF-1. (f) A focal weak positivity of round cells (black arrowhead) for synaptophysin was observed in this portion, but the surface cells (black arrow) showed negative for Syn. (a, H&E staining with original magnification of 200 ×; b-c, H&E staining with original magnification of 400 ×; d-f, immunohistochemical staining with original magnification of 400 ×).
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Figure 3: Postoperative photomicrographs of lesion in PSH portion. (a) the tumor was composed of sheets of round cells with scattered surface cuboidal cells forming small tubules. (b) The surface cuboidal cells demonstrated vacuolated and foamy cytoplasm with focal mild nuclear atypia (black arrow). The round cells showed uniform, medium-size polygonal nuclei with moderate amounts of pale, eosinophilic or clear cytoplasm (black arrowhead). (c) In some area, papillary pattern with hyalinizing stalks could be obsreved. Both surface cuboidal cells and round cells could be found in this structure. (d) Immunohistochemically, positivity of surface cuboidal cells, but negativity of round cells for pancytokeratin was found in tumor. (e) Both surface (black arrow) and round cells (black arrowhead) showed strongly positive for TTF-1. (f) A focal weak positivity of round cells (black arrowhead) for synaptophysin was observed in this portion, but the surface cells (black arrow) showed negative for Syn. (a, H&E staining with original magnification of 200 ×; b-c, H&E staining with original magnification of 400 ×; d-f, immunohistochemical staining with original magnification of 400 ×).

Mentions: Under the microscopical examination, part of nodular mass, measuring approximately 1.2 cm in longest diameter, demonstrated classical solid pattern of PSH with varying proportions of surface cuboidal cells and pale round cells. In this area, the mass was composed of sheets of round cells with scattered surface cuboidal cells forming small tubules (Figure 3A). The surface cuboidal cells resembling type II alveolar cells demonstrated vacuolated and foamy cytoplasm with focal mild nuclear atypia. While the round cells were pale round cells showed uniform, medium-size polygonal nuclei with moderate amounts of pale, eosinophilic or clear cytoplasm (Figure 3B). In some area, papillary pattern with hyalinizing stalks was also obsreved, and the surface cuboidal cells lined the papillae surface (Figure 3C). Neither necrosis nor mitotic activity was found in PSH area. Immunohistochemically, round cells were positive to epithelial membrane antigen (EMA), thyroid transcription factor-1 (TTF-1), Estrogen receptor (ER), progesterone receptor (PR), and focally weak positive for synaptophysin (Syn), but negative for pancytokeractin (AE1/AE3). Surface cells were strongly positive for AE1/AE3, EMA and TTF-1, but negative for ER, PR, Syn and carcinoembryonic antigen (CEA) (Figure 3D-F). Interestingly, however, acinar adenocarcinoma could be observed in other area of the same nodular mass. In this area, measuring approximately 1.0 cm in longest diameter, the tumor cells formed irregular-shaped glands with cytologically malignant cells exhibiting hyperchromatic nuclei in a fibroblastic stroma (Figure 4A). There was no round cells found to distribute in the interstitial portion of gland structures (Figure 4B). The field of PSH and acinar adenocarcinoma was separated in the mass, and there was no gradual transition of these two parts observed in mass. Immunohistochemically, tumor cells of adenocarcinoma were positive for AE1/AE3, EMA, TTF-1 and CEA, but negative for ER, PR, and Syn (Figure 4C-E). In addition, no TTF-1-positive stromal cells could be observed in adenocarcinoma portion of mass by immunohistochemical staining. Based on above findings, a final histological diagnosis of PSH combined with primary adenocarcinoma was made. After surgery, 6 months follow-up was performed without further treatment. There was no evidence of tumor recurrence during the period of postoperative follow-up.


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)

Postoperative photomicrographs of lesion in PSH portion. (a) the tumor was composed of sheets of round cells with scattered surface cuboidal cells forming small tubules. (b) The surface cuboidal cells demonstrated vacuolated and foamy cytoplasm with focal mild nuclear atypia (black arrow). The round cells showed uniform, medium-size polygonal nuclei with moderate amounts of pale, eosinophilic or clear cytoplasm (black arrowhead). (c) In some area, papillary pattern with hyalinizing stalks could be obsreved. Both surface cuboidal cells and round cells could be found in this structure. (d) Immunohistochemically, positivity of surface cuboidal cells, but negativity of round cells for pancytokeratin was found in tumor. (e) Both surface (black arrow) and round cells (black arrowhead) showed strongly positive for TTF-1. (f) A focal weak positivity of round cells (black arrowhead) for synaptophysin was observed in this portion, but the surface cells (black arrow) showed negative for Syn. (a, H&E staining with original magnification of 200 ×; b-c, H&E staining with original magnification of 400 ×; d-f, immunohistochemical staining with original magnification of 400 ×).
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
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Figure 3: Postoperative photomicrographs of lesion in PSH portion. (a) the tumor was composed of sheets of round cells with scattered surface cuboidal cells forming small tubules. (b) The surface cuboidal cells demonstrated vacuolated and foamy cytoplasm with focal mild nuclear atypia (black arrow). The round cells showed uniform, medium-size polygonal nuclei with moderate amounts of pale, eosinophilic or clear cytoplasm (black arrowhead). (c) In some area, papillary pattern with hyalinizing stalks could be obsreved. Both surface cuboidal cells and round cells could be found in this structure. (d) Immunohistochemically, positivity of surface cuboidal cells, but negativity of round cells for pancytokeratin was found in tumor. (e) Both surface (black arrow) and round cells (black arrowhead) showed strongly positive for TTF-1. (f) A focal weak positivity of round cells (black arrowhead) for synaptophysin was observed in this portion, but the surface cells (black arrow) showed negative for Syn. (a, H&E staining with original magnification of 200 ×; b-c, H&E staining with original magnification of 400 ×; d-f, immunohistochemical staining with original magnification of 400 ×).
Mentions: Under the microscopical examination, part of nodular mass, measuring approximately 1.2 cm in longest diameter, demonstrated classical solid pattern of PSH with varying proportions of surface cuboidal cells and pale round cells. In this area, the mass was composed of sheets of round cells with scattered surface cuboidal cells forming small tubules (Figure 3A). The surface cuboidal cells resembling type II alveolar cells demonstrated vacuolated and foamy cytoplasm with focal mild nuclear atypia. While the round cells were pale round cells showed uniform, medium-size polygonal nuclei with moderate amounts of pale, eosinophilic or clear cytoplasm (Figure 3B). In some area, papillary pattern with hyalinizing stalks was also obsreved, and the surface cuboidal cells lined the papillae surface (Figure 3C). Neither necrosis nor mitotic activity was found in PSH area. Immunohistochemically, round cells were positive to epithelial membrane antigen (EMA), thyroid transcription factor-1 (TTF-1), Estrogen receptor (ER), progesterone receptor (PR), and focally weak positive for synaptophysin (Syn), but negative for pancytokeractin (AE1/AE3). Surface cells were strongly positive for AE1/AE3, EMA and TTF-1, but negative for ER, PR, Syn and carcinoembryonic antigen (CEA) (Figure 3D-F). Interestingly, however, acinar adenocarcinoma could be observed in other area of the same nodular mass. In this area, measuring approximately 1.0 cm in longest diameter, the tumor cells formed irregular-shaped glands with cytologically malignant cells exhibiting hyperchromatic nuclei in a fibroblastic stroma (Figure 4A). There was no round cells found to distribute in the interstitial portion of gland structures (Figure 4B). The field of PSH and acinar adenocarcinoma was separated in the mass, and there was no gradual transition of these two parts observed in mass. Immunohistochemically, tumor cells of adenocarcinoma were positive for AE1/AE3, EMA, TTF-1 and CEA, but negative for ER, PR, and Syn (Figure 4C-E). In addition, no TTF-1-positive stromal cells could be observed in adenocarcinoma portion of mass by immunohistochemical staining. Based on above findings, a final histological diagnosis of PSH combined with primary adenocarcinoma was made. After surgery, 6 months follow-up was performed without further treatment. There was no evidence of tumor recurrence during the period of postoperative follow-up.

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