Lung (2015) 193:447–448 DOI 10.1007/s00408-015-9711-0
Sclerosing Hemangioma of the Lung Mimicking Pulmonary Metastasis G. De Luca1 • N. Martucci1 • S. Setola2 • G. Rocco1
Received: 31 August 2014 / Accepted: 5 March 2015 / Published online: 12 March 2015 Ó Springer Science+Business Media New York 2015
Abstract 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. Keywords Pulmonary sclerosing hemangioma Solitary pulmonary nodule 18FDG PET A 55-year-old female was admitted to our hospital complaining non-productive cough for the past 3 months. Her medical history revealed a left hemicolectomy for colon cancer 20 months previously. The chest X-ray demonstrated a single, small, well-rounded, and defined lesion of
& G. De Luca [email protected] 1
Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori-IRCCS ‘‘Fondazione G. Pascale’’, Via M. Semmola, 80016 Naples, Italy
2
Department of Radiodiagnostics, Istituto Nazionale TumoriIRCCS ‘‘Fondazione G.Pascale’’, Naples, Italy
the left lung (Fig. 1a). A contrast-enhanced computed tomography (CT) scan of the thorax showed a well-circumscribed and homogeneous solid tumor of 2.2 cm in size. The tumor was located near the left border of the heart in the lower lobe of the left lung (Fig. 1b). Whole body FDG PET demonstrated high FDG accumulation in the mass with a maximal standardized uptake value (SUV max) of 3.7 in the early phase (Fig. 1c), without evidence for metabolically active lymphadenopathy or distant metastases. A CT-guided percutaneous needle biopsy of the tumor was performed, but was not conclusive. The patient underwent surgical exploration and a wedge resection of the lung was performed. Intraoperative frozen section examinations, suggested sclerosing hemangioma (SH). Permanent fixed histologic specimens in fact showed a proliferation of round stromal cells and cuboid surface cells in papillary, sclerotic, solid, and hemorrhagic patterns (Fig. 1d). The stromal cells showed a typical expression of TTF-1. The proliferation index was less than 1 %. The patient was discharged home after 3 days, and 2 years after surgery, the patient was alive and had no evidence of recurring disease. SH is a rare, benign lung tumor, probably accounting for approximately 3–5 % of all benign lung lesions, believed to originate from pneumocyte type II cell [1]. Clinical and radiological characteristics of SH are not specific enough to diagnose the condition preoperatively, the high uptake on PET scan cannot be used to exclude the diagnosis of SH [2]. Our patient demonstrated substantial uptake by the SH, which simulated that of malignancy, and the lesion was preoperatively believed to be a lung metastasis. Surgery is usually indicated for definite diagnosis and treatment [1]. Intraoperative frozen sections plays an important role, in fact may prevent unnecessary resection of lung tissue.
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Lung (2015) 193:447–448
Fig. 1 a Chest X-ray showing a well-rounded and defined lesion of the left lung localized in paracardiac area (white arrow). b Contrast-enhanced CT at lung window setting showing a sharply demarcated and homogeneous solid tumor of 2.2 cm in size located near the left border of the heart in the lower lobe of the left lung (white arrow). c 18F-FDG PET image revealing that the mass is hypermetabolic (maximal SUV of 3.7) (white arrow). d Histologic picture showing a proliferation of round stromal cells and cuboid surface cells in papillary, sclerotic, solid, and hemorrhagic patterns (hematoxylin and eosin stain, original magnification 910)
Conflict of interest The authors have no conflict of interest to disclose.
References 1. Lei Y, Yang D, Jun-Zhang R, Zhi Y, Zi-Tang W (2012) Treatment of 28 patient with sclerosing hemangioma (SH) of the lung. J Cardiothorac Surg 7:34
123
2. Lin KH, Chang CP, Liu RS, Wang SJ (2011) F-18 FDG PET/CT in evaluation of pulmonary sclerosing hemangioma. Clin Nucl Med 36(5):341–343
Sclerosing Hemangioma of the Lung Mimicking Pulmonary Metastasis G. De Luca1 • N. Martucci1 • S. Setola2 • G. Rocco1
Received: 31 August 2014 / Accepted: 5 March 2015 / Published online: 12 March 2015 Ó Springer Science+Business Media New York 2015
Abstract 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. Keywords Pulmonary sclerosing hemangioma Solitary pulmonary nodule 18FDG PET A 55-year-old female was admitted to our hospital complaining non-productive cough for the past 3 months. Her medical history revealed a left hemicolectomy for colon cancer 20 months previously. The chest X-ray demonstrated a single, small, well-rounded, and defined lesion of
& G. De Luca [email protected] 1
Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori-IRCCS ‘‘Fondazione G. Pascale’’, Via M. Semmola, 80016 Naples, Italy
2
Department of Radiodiagnostics, Istituto Nazionale TumoriIRCCS ‘‘Fondazione G.Pascale’’, Naples, Italy
the left lung (Fig. 1a). A contrast-enhanced computed tomography (CT) scan of the thorax showed a well-circumscribed and homogeneous solid tumor of 2.2 cm in size. The tumor was located near the left border of the heart in the lower lobe of the left lung (Fig. 1b). Whole body FDG PET demonstrated high FDG accumulation in the mass with a maximal standardized uptake value (SUV max) of 3.7 in the early phase (Fig. 1c), without evidence for metabolically active lymphadenopathy or distant metastases. A CT-guided percutaneous needle biopsy of the tumor was performed, but was not conclusive. The patient underwent surgical exploration and a wedge resection of the lung was performed. Intraoperative frozen section examinations, suggested sclerosing hemangioma (SH). Permanent fixed histologic specimens in fact showed a proliferation of round stromal cells and cuboid surface cells in papillary, sclerotic, solid, and hemorrhagic patterns (Fig. 1d). The stromal cells showed a typical expression of TTF-1. The proliferation index was less than 1 %. The patient was discharged home after 3 days, and 2 years after surgery, the patient was alive and had no evidence of recurring disease. SH is a rare, benign lung tumor, probably accounting for approximately 3–5 % of all benign lung lesions, believed to originate from pneumocyte type II cell [1]. Clinical and radiological characteristics of SH are not specific enough to diagnose the condition preoperatively, the high uptake on PET scan cannot be used to exclude the diagnosis of SH [2]. Our patient demonstrated substantial uptake by the SH, which simulated that of malignancy, and the lesion was preoperatively believed to be a lung metastasis. Surgery is usually indicated for definite diagnosis and treatment [1]. Intraoperative frozen sections plays an important role, in fact may prevent unnecessary resection of lung tissue.
123
448
Lung (2015) 193:447–448
Fig. 1 a Chest X-ray showing a well-rounded and defined lesion of the left lung localized in paracardiac area (white arrow). b Contrast-enhanced CT at lung window setting showing a sharply demarcated and homogeneous solid tumor of 2.2 cm in size located near the left border of the heart in the lower lobe of the left lung (white arrow). c 18F-FDG PET image revealing that the mass is hypermetabolic (maximal SUV of 3.7) (white arrow). d Histologic picture showing a proliferation of round stromal cells and cuboid surface cells in papillary, sclerotic, solid, and hemorrhagic patterns (hematoxylin and eosin stain, original magnification 910)
Conflict of interest The authors have no conflict of interest to disclose.
References 1. Lei Y, Yang D, Jun-Zhang R, Zhi Y, Zi-Tang W (2012) Treatment of 28 patient with sclerosing hemangioma (SH) of the lung. J Cardiothorac Surg 7:34
123
2. Lin KH, Chang CP, Liu RS, Wang SJ (2011) F-18 FDG PET/CT in evaluation of pulmonary sclerosing hemangioma. Clin Nucl Med 36(5):341–343
