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      Pulmonary Sclerosing Pneumocytoma of the Lung: CT Characteristics in a Large Series of a Tertiary Referral Center

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      Author(s): , MD, PhD, , MD, PhD, , MD, , MD, , MD, , MD, PhD, , PhD
      Editor(s):
      Publication date (Electronic):
      Journal: Medicine
      Publisher: Wolters Kluwer Health

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          Abstract

          The purpose of this study is to describe the detailed clinical, chest computed tomography (CT), and 18F-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.

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          Most cited references22

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          A clinicopathologic study of 100 cases of pulmonary sclerosing hemangioma with immunohistochemical studies: TTF-1 is expressed in both round and surface cells, suggesting an origin from primitive respiratory epithelium.

          M Devouassoux-Shisheboran, T. Hayashi, R Linnoila … (2000)
          Pulmonary sclerosing hemangioma (SH) is a lung neoplasm of uncertain histogenesis that is composed of two major cell types: surface and round cells. The authors studied 100 cases of pulmonary SH that presented as a peripheral (95%), solitary (96%) mass of less than 3 cm in diameter (74%) in asymptomatic patients who were mostly women (83%) with a mean age of 46.2 years. Immunohistochemistry of multiple epithelial, mesothelial, pneumocyte, neuroendocrine, and mesenchymal markers was performed on 47 cases to investigate the histogenesis of this neoplasm. Both surface and round cells stained with epithelial membrane antigen (EMA) and thyroid transcription factor-1 (TTF-1) in more than 90% of cases; however, the round cells were uniformly negative for pancytokeratin and positive for cytokeratin-7 and CAM 5.2 in only 31% and 17% of cases, respectively. Surfactant proteins A and B as well as Clara cell antigen were positive in varying numbers of surface cells but they were negative in the round cells. Neuroendocrine cells either as isolated scattered cells or as a tumorlet within the center of SH were detected (chromogranin, Leu-7, synaptophysin positive) in three cases. The expression of TTF-1 in the absence of surfactant proteins A and B and Clara cell antigens in the round cells of SH suggests that they are derived from primitive respiratory epithelium. The alveolar pneumocytes and neuroendocrine cells may either represent phenotypic differentiation of a primitive respiratory epithelial component or they may correspond to non-neoplastic entrapped or hyperplastic elements. The concomitant positivity of both cell types in SH for TTF-1 and EMA, and the negativity of round cells for pancytokeratin and neuroendocrine markers, provide useful clues not only for histogenesis but also for the diagnosis of this lung neoplasm.
          Article 0 comments Cited 62 times – based on 0 reviews     Review now
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            Clinicopathological analysis of pulmonary sclerosing hemangioma.

            Y Haga, Yasumitsu Moriya, Takehiko Fujisawa … (2004)
            Sclerosing hemangiomas of the lung are uncommon tumors and are thought to be benign. However, the histogenesis and clinicopathological features of these tumors have not been elucidated. We analyzed the clinicopathological features of 26 sclerosing hemangiomas. The immunoreactivity for Ki-67 and p53 of sclerosing hemangiomas was determined and compared with that of pathological stage 1 pulmonary papillary adenocarcinomas. The patients of sclerosing hemangioma were predominantly female. Eighteen patients were detected as a result of routine medical examinations and 15 were nonsmokers. Seven patients underwent tumor enucleation, 10 underwent a wedge resection, and 9 underwent a lobectomy. The mean tumor size was 2.2 cm (range 1 to 5 cm). Pathological findings demonstrated a papillary pattern in 23 cases, sclerotic pattern in 26 cases, hemorrhagic pattern in 22 cases and a solid pattern in 25 cases. Twenty-five cases had an excellent prognosis with no evidence of recurrence following surgery. However, 1 patient who had undergone a wedge resection developed a local recurrence and required an additional wedge resection. The Ki-67 labeling index of sclerosing hemangiomas was significantly lower than that of adenocarcinomas, whereas the Ki-67 labeling index of the recurrent case was 0.4%. No significant immunohistochemical staining for p53 was observed in sclerosing hemangioma cases. Sclerosing hemangioma exhibits various histologic findings. Although we experienced one case with a recurrent tumor, sclerosing hemangiomas did not exhibit malignant behavior.
            Article 0 comments Cited 24 times – based on 0 reviews     Review now
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              Pulmonary sclerosing hemangioma presenting as solitary pulmonary nodule: dynamic CT findings and histopathologic comparisons.

              O Jung Kwon, Joungho Han, Semin Chong … (2006)
              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. On dynamic CT, sclerosing hemangioma has strong and rapid enhancement attributed histopathologically to the presence of hemangiomatous or papillary components in the tumor.
              Article 0 comments Cited 22 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: January 2015
                Publication date (Electronic): 30 January 2015
                Volume: 94
                Issue: 4
                Electronic Location Identifier: e498
                Affiliations
                Department of Radiology and Research Institute of Radiology (SYS), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, and Department of Radiology (SYS), Graduate School of Medicine, Kyung Hee University, Seoul, Korea; Department of Radiology and Research Institute of Radiology (MYK, SYO, HJL), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; Department of Pathology (SAH, SJJ), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; and Department of Healthcare Management (S-SK), Cheongju University, Cheongju, Korea.
                Author notes
                Correspondence: Mi Young Kim, MD, PhD, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea, Republic of (e-mail: mimowdr@ 123456gmail.com ; momowdr@ 123456naver.com ).
                Article
                Accession ID: 00498
                DOI: 10.1097/MD.0000000000000498
                PMC ID: 4602969
                PubMed ID: 25634202
                SO-VID: b9811941-7ac1-4be5-b30f-14c5e2c9e989
                Copyright © Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
                License:

                This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                Date received : 24 November 2014
                Date revision received : 5 January 2015
                Date accepted : 6 January 2015
                Categories
                Subject: 6800
                Subject: Article
                Subject: Diagnostic Accuracy Study
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