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Pulmonary sclerosing hemangioma presenting with dense spindle stroma cells: a potential diagnostic pitfall.

Lin XY, Wang Y, Fan CF, Liu Y, Yu JH, Dai SD, Wang L, Wang EH - Diagn Pathol (2012)

Bottom Line: The significance of spindle cells change is unclear for us.To our knowledge, this is the first reported case of PSH showing dense spindle cells in solid area.This case represents a potential diagnostic pitfall, as it may be misdiagnosed as a mesenchymal tumor such as inflammatory myofibroblastic tumor, synovial sarcoma, solitary fibrous tumor, leiomyoma, or even mesothelioma, especially if the specimen is limited or from fine- needle aspiration.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.

ABSTRACT

Unlabelled: Pulmonary sclerosing hemangioma (PSH) is an uncommon pulmonary tumor. Histologically, PSH typically consists of two types of cells, surface cuboidal cells and polygonal cells, four architectural patterns including papillary, sclerotic, solid, and hemorrhagic. Herein, we present a case of PSH in a 59-year-old Chinese female. The tumor was predominantly composed of solid area presenting with diffuse spindle cells rather than polygonal cells. Focally, classical papillary and sclerotic area could be seen. Immunohistochemical staining showed that the spindle cells were positive for TTF-1, EMA, Actin(SM) and Vimentin, and negative for cytokeratin, cytokeratin7, cytokeratin5/6, surfactant apoprotein A, surfactant apoprotein B, CD34, CD99, S-100, HMB45, Desmin, Synaptophysin, CD56, ALK and Calretinin. The immunophenotype of the dense spindle cells in this case was similar to that of the polygonal cells, and thus the spindle cells may be the variants of polygonal cells. Based on morphologic features and the immunohistochemical profile, the tumor was diagnosed as a PSH. The significance of spindle cells change is unclear for us. To our knowledge, this is the first reported case of PSH showing dense spindle cells in solid area. This case represents a potential diagnostic pitfall, as it may be misdiagnosed as a mesenchymal tumor such as inflammatory myofibroblastic tumor, synovial sarcoma, solitary fibrous tumor, leiomyoma, or even mesothelioma, especially if the specimen is limited or from fine- needle aspiration.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1235401622806126.

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A, The spindle tumor cells were arranged in bundles and whirling patterns.B, The scattered lymphocytes (arrows) could be seen in the background of spindle cells. C, The spindle cells had no marked cellular atypia, with pale to eosinophilic cytoplasm, fine chromatin and inconspicuous nucleoli. D, Papillary area showed the surface cuboidal cells and polygonal cells in the stroma. E, Sclerotic area was characterized by hyalinized collagen with scarcely distributed polygonal cells and adenoidal structures consisting of cuboidal cells. F, An adenoidal structure covered with cuboidal cells could be seen in spindle cells area. G, H, The border of the tumor (arrows) was relatively well circumscribed.
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Figure 1: A, The spindle tumor cells were arranged in bundles and whirling patterns.B, The scattered lymphocytes (arrows) could be seen in the background of spindle cells. C, The spindle cells had no marked cellular atypia, with pale to eosinophilic cytoplasm, fine chromatin and inconspicuous nucleoli. D, Papillary area showed the surface cuboidal cells and polygonal cells in the stroma. E, Sclerotic area was characterized by hyalinized collagen with scarcely distributed polygonal cells and adenoidal structures consisting of cuboidal cells. F, An adenoidal structure covered with cuboidal cells could be seen in spindle cells area. G, H, The border of the tumor (arrows) was relatively well circumscribed.

Mentions: Grossly, the tumor measuring 4.5×4.1×3.2cm was well-circumscribed, and the cut surface showed grey-white in color. Histologically, the tumor was predominantly made up of spindle cells which were arranged in solid sheets, bundles or whirling pattern. The spindle cells were bland, with clear cytoplasm, fine chromatin and inconspicuous nucleoli, and no marked cellular atypia could be observed. The mitosis is rare. In focal area, the classical sclerotic and papillary pattern could be seen. The cuboidal cells were arranged in a tight monolayer on the surface of the papillary pattern, while the polygonal cells were distributed in the stroma. The sclerotic pattern showed abundant hyalinized collagen with almost no polygonal cells. A few adenoidal structures consisting of cuboidal cells could also be seen in spindle cells solid area and sclerotic area. In addition, inflammatory cells including lymphocytes, plasmocytes and histiocytes were scattered in all areas (Figure1). No lymph node metastases were found in excised lymph nodes.


Pulmonary sclerosing hemangioma presenting with dense spindle stroma cells: a potential diagnostic pitfall.

Lin XY, Wang Y, Fan CF, Liu Y, Yu JH, Dai SD, Wang L, Wang EH - Diagn Pathol (2012)

A, The spindle tumor cells were arranged in bundles and whirling patterns.B, The scattered lymphocytes (arrows) could be seen in the background of spindle cells. C, The spindle cells had no marked cellular atypia, with pale to eosinophilic cytoplasm, fine chromatin and inconspicuous nucleoli. D, Papillary area showed the surface cuboidal cells and polygonal cells in the stroma. E, Sclerotic area was characterized by hyalinized collagen with scarcely distributed polygonal cells and adenoidal structures consisting of cuboidal cells. F, An adenoidal structure covered with cuboidal cells could be seen in spindle cells area. G, H, The border of the tumor (arrows) was relatively well circumscribed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539896&req=5

Figure 1: A, The spindle tumor cells were arranged in bundles and whirling patterns.B, The scattered lymphocytes (arrows) could be seen in the background of spindle cells. C, The spindle cells had no marked cellular atypia, with pale to eosinophilic cytoplasm, fine chromatin and inconspicuous nucleoli. D, Papillary area showed the surface cuboidal cells and polygonal cells in the stroma. E, Sclerotic area was characterized by hyalinized collagen with scarcely distributed polygonal cells and adenoidal structures consisting of cuboidal cells. F, An adenoidal structure covered with cuboidal cells could be seen in spindle cells area. G, H, The border of the tumor (arrows) was relatively well circumscribed.
Mentions: Grossly, the tumor measuring 4.5×4.1×3.2cm was well-circumscribed, and the cut surface showed grey-white in color. Histologically, the tumor was predominantly made up of spindle cells which were arranged in solid sheets, bundles or whirling pattern. The spindle cells were bland, with clear cytoplasm, fine chromatin and inconspicuous nucleoli, and no marked cellular atypia could be observed. The mitosis is rare. In focal area, the classical sclerotic and papillary pattern could be seen. The cuboidal cells were arranged in a tight monolayer on the surface of the papillary pattern, while the polygonal cells were distributed in the stroma. The sclerotic pattern showed abundant hyalinized collagen with almost no polygonal cells. A few adenoidal structures consisting of cuboidal cells could also be seen in spindle cells solid area and sclerotic area. In addition, inflammatory cells including lymphocytes, plasmocytes and histiocytes were scattered in all areas (Figure1). No lymph node metastases were found in excised lymph nodes.

Bottom Line: The significance of spindle cells change is unclear for us.To our knowledge, this is the first reported case of PSH showing dense spindle cells in solid area.This case represents a potential diagnostic pitfall, as it may be misdiagnosed as a mesenchymal tumor such as inflammatory myofibroblastic tumor, synovial sarcoma, solitary fibrous tumor, leiomyoma, or even mesothelioma, especially if the specimen is limited or from fine- needle aspiration.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China.

ABSTRACT

Unlabelled: Pulmonary sclerosing hemangioma (PSH) is an uncommon pulmonary tumor. Histologically, PSH typically consists of two types of cells, surface cuboidal cells and polygonal cells, four architectural patterns including papillary, sclerotic, solid, and hemorrhagic. Herein, we present a case of PSH in a 59-year-old Chinese female. The tumor was predominantly composed of solid area presenting with diffuse spindle cells rather than polygonal cells. Focally, classical papillary and sclerotic area could be seen. Immunohistochemical staining showed that the spindle cells were positive for TTF-1, EMA, Actin(SM) and Vimentin, and negative for cytokeratin, cytokeratin7, cytokeratin5/6, surfactant apoprotein A, surfactant apoprotein B, CD34, CD99, S-100, HMB45, Desmin, Synaptophysin, CD56, ALK and Calretinin. The immunophenotype of the dense spindle cells in this case was similar to that of the polygonal cells, and thus the spindle cells may be the variants of polygonal cells. Based on morphologic features and the immunohistochemical profile, the tumor was diagnosed as a PSH. The significance of spindle cells change is unclear for us. To our knowledge, this is the first reported case of PSH showing dense spindle cells in solid area. This case represents a potential diagnostic pitfall, as it may be misdiagnosed as a mesenchymal tumor such as inflammatory myofibroblastic tumor, synovial sarcoma, solitary fibrous tumor, leiomyoma, or even mesothelioma, especially if the specimen is limited or from fine- needle aspiration.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1235401622806126.

Show MeSH
Related in: MedlinePlus