Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pulmonary sclerosing pneumocytoma
- Radiologic Findings
- Figs 1-2. Chest radiographs show a large, well-demarcated mass with surrounding ground glass opacity in the right middle lung field.
Fig 3. Coronal lung window setting image of the chest CT scan shows a 4.8 x 6.4 cm, well-demarcated mass in the right middle lobe, with surrounding ground glass opacity in adjacent all three lobes of the right lung.
Figs 4-5. Axial mediastinal window setting images of the chest CT scan show the mass to be abutting the right atrium and heterogeneously enhancing after contrast infusion.
The patient underwent CT-guided biopsy of the lung, which showed inconclusive results. The patient then underwent lobectomy of the right middle lobe, which revealed the mass to be sclerosing pneumocytoma surrounded by diffuse intraalveolar hemorrhage.
- Brief Review
- Pulmonary sclerosing pneumocytomas (PSP), previously known as pulmonary sclerosing hemangiomas, are rare benign neoplasms of the lung. It typically presents in middle age (mean age of 46 years), with female predilection. Most patients are asymptomatic. Symptoms, if present, include hemoptysis, cough, chest pain, dyspnea, and pleurisy. The lesions range from 0.8 to 8.2 cm in diameter, but most are less than 3 cm in diameter.
Histologically, PSPs show proliferation of type 2 pneumocytes, consisting of four major histologic components: solid, papillary, sclerotic, and hemangiomatous.
PSPs typically presents on chest radiograph as a solitary, well-defined oval to rounded nodular lesion. On CT, PSPs show a smoothly marginated, homogeneously enhancing, round or oval nodule/mass with foci of calcification and air meniscus. Differentiation from lung cancer may be difficult on CT. A recent study reported that PSPs most likely present with a signle lesion (92.1%) and have smooth boundary (65.8%) and an oval shape (65.8%), with a mean diameter of 2.27 cm. Four key CT signs are marginal pseudocapsule sign (50%), overlying vessel sign (26.3%), air-gap sign (2.6%), and rarely, halo sign (17.1%). Our case demonstrates the halo sign, which is known to be caused by peritumoral hemorrhage and tumor contraction.
- Please refer to
Case 142, Case 148, Case 168, Case 318, Case 401, Case 540, Case 646, Case 730, Case 1023, Case 1035, -
Thoracic Imaging 2003- Korean & Japanese Film Interpretation - Case 3,
- References
- 1. Shin SY, Kim MY, Oh SY, et al. Pulmonary sclerosing pneumocytoma of the lung: CT characteristics in a large series of a tertiary referral center. Medicine (Baltimore). 2015 Jan;94(4):e498.
2. Lim JH, Lee N, Choi DW, et al. Pulmonary sclerosing pneumocytoma mimicking lung cancer: Case report and review of the literature. Thorac Cancer. 2016 Jul;7(4):508-11.
3. Furuya K, Yasumori K, Takeo S, et al. Lung CT: Part 1, Mimickers of lung cancer--spectrum of CT findings with pathologic correlation. AJR 2012; 199:W454?W463
4. Nam JE, Ryu YH, Cho SH, et al. Air-trapping zone surrounding sclerosing hemangioma of the lung. J Comp Assist Tomogr. 2002;26:358–361.
- Keywords
- lung, Benign neoplasm, Sclerosing pneumocytoma,