A rare case of pulmonary sclerosing hemagioma with lymph node metastasis and review of the literature.

Pulmonary sclerosing hemagioma (SH) is an uncommon tumor with malignance potential. Clinically this disease is regarded as benign but extremely rare cases can have lymph node metastasis. Up to date, there have been only very few reports concerning SH with lymph node metastasis. In this paper we reported one pulmonary SH case with lymph node metastasis and additionally overviewed the clinical and pathological features of SH. A young-aged female was found incidentally to have a nodule in the right upper lung. This patient presented no cough, no hemoptysis and chest pain. Computed tomography (CT) scan indicated a large mass in the right upper lung and enlarged lymph nodes in the right hilum. The patient underwent lobectomy of the right upper lung. Histologically, the tumor demonstrated typical features of SH and was consisted of angiomatoid areas, sclerosis, papillary structures lined with cuboidal cells and sheets of round to polygonal cells. Polygonal cells in some solid areas presented abnormal enlarged nuclei and increased karyoplasmic ratio; tumor giant cells were noted; whereas mitosis was not observed. One peribronchial lymph node was noted for SH metastasis and the metastatic tissue were consisted of polygonal cells. Immunohistochemistry (IHC) revealed that both surface-lining cuboidal and polygonal cells expressed EMA and thyroid transcription factor 1 (TTF-1), but were negative for CD34, VIII factor, CD68 and Claratinin. The polygonal cells showed relatively higher expression of Ki-67 and p53 than the surface-lining cells. Postoperatively, the patient received no chemotherapy or radiotherapy and no recurrence 2 years after surgery was noted.

Sclerosing hemangioma of the lung mimicking pulmonary metastasis.

Sclerosing hemangioma (SH) of the lung is a rare, benign neoplasm, initially thought to be of vascular origin, but immunohistochemical results suggest an origin from primitive respiratory epithelium. We report a case of SH initially misdiagnosed as malignant due to the strong FDG-PET uptake.

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

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.

Sclerosing hemangioma, presenting as a pneumonic pattern with mucinous adenomatous hyperplasia of the lung.

Pulmonary sclerosing hemangioma is generally considered a rare neoplasm presenting as a solitary benign nodule. During routine medical examination multiple abnormal nodular shadows were detected in the right lower lung field on chest X-ray in a 48-year-old asymptomatic woman. The patient underwent wedge resection for the pulmonary lesion. The resected lung had numerous scattered tiny nodules and small nodules congregated together, forming larger nodules. All of these lesions had typical features of sclerosing hemangioma. The authors call this unusual growth pattern of sclerosing hemangioma a 'pneumonic pattern'. Adjacent to the largest lesion, a relatively well-defined small mucinous lesion composed of mucinous tall columnar cells and basaloid squamous cells was detected. Because this lesion did not have expression of thyroid transcription factor-1, it is described as mucinous adenomatous hyperplasia.

Sclerosing haemangioma with a predominant sclerotic pattern: an unusual pulmonary lesion which can be misdiagnosed.

AIMS: An unusual sclerosing haemangioma of the lung with a predominant sclerotic pattern is described. MAIN RESULTS AND CONCLUSIONS: The patient was a 51-year-old male, presenting with a well-circumscribed nodule, 0,6 cm in diameter, located in the lower lobe of the left lung. He is alive and well 9 years after surgical excision of the nodule. Microscopically, the lesion was well demarcated and mostly composed of sclerotic tissue, with numerous irregular entrapped alveolar spaces The characteristic bland, round cells with abundant pale cytoplasm, immunohistochemically positive for TTF-1 and negative for cytokeratin, were limited to small clusters embedded in the stroma at the periphery of the nodule. The most important differential diagnostic considerations of the sclerotic variant of pulmonary sclerosing haemangioma are briefly discussed.