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Weekly Chest CasesArchive of Old Cases

Case No : 1023 Date 2017-06-05

  • Courtesy of Won Jin Choi, Eun-ju Kang, Ki-Nam Lee / Dong-A University Hospital
  • Age/Sex 62 / F
  • Chief Complaintincidental finding on health screening
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Sclerosing pneumocytoma
Radiologic Findings
Chest radiographs (Fig 1, 2) show well defined small nodule in left infrahilar area.
Axial chest CT images (Fig 3-5) show 2.3cm sized well defined sharply marginated enhancing nodule in LLL, abutting left atrium. Non-enhanced CT scan (Fig 3) shows subtle high attenuating foci in the peripheral portion of the nodule. Coronal reformatted image (Fig 6) shows mild heterogenous enhancement of the nodule.
The patient underwent surgical mass excision (wedge resection of LLL). The pathological diagnosis was sclerosing pneumocytoma.
Brief Review
Pulmonary sclerosing pneumocytomas (PSP), previously known as pulmonary sclerosing hemangiomas (PSH), also known as are rare benign neoplasms of the lung and typically presents in middle age (30-50 years of age). There is a recognized female predilection. Most patients are asymptomatic. Symptoms if present will 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 3.5 cm in diameter.
Histologically, the essence is proliferation of type 2 pneumocytes, and a pneumocytoma consists of four major histologic components: solid, papillary, sclerotic, and hemangiomatous.
PSP typically presents on chest radiograph as a solitary, well-defined oval to rounded nodular lesion (shadow). Occasionally may contain areas of calcification and air-meniscus sign
CT shows a smoothly marginated, homogeneously well-enhanced, 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 most patients had a single lesion (92.1%), smooth boundary (65.8%), and oval shape (65.8%), with a mean diameter of 2.27 cm. CT signs included marginal pseudocapsule (50%), overlying vessel (26.3%), air gap (2.6%), and halo sign (17.1%).
PSP can be very challenging to diagnose in frozen sections, small biopsies, and cytology where they can easily be mistaken for adenocarcinoma or carcinoid tumors. These tumors typically have a benign clinical course, with metastasis being exceedingly rare. Treatment of PSP involves surgical resection and the prognosis is favorable.
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. Cheung YC, Ng SH, Chang JWC, et al. Histopathological and CT features of pulmonary sclerosing haemangiomas. Clin Radiol 2003;58:630e5.
Keywords
Lung, Pulmonary sclerosing pneumocytoma,

No. of Applicants : 101

▶ Correct Answer : 32/101,  31.7%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Korea University Guro Hospital , Korea (South) Bit Na Park
  • - Korea University Guro Hospital , Korea (South) PARK SOYEON
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Seoul National University Hospital , Korea (South) SU YEON AHN
  • - Busan National University Hospital , Korea (South) ILWAN SON
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Busan National University Hospital , Korea (South) LEE YOU JIN
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - Pusan national university hospital , Korea (South) SeungHyun Lee
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Seoul National University Hospital , Korea (South) JI EUN KIM
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chungbuk national university , Korea (South) Yong Hun Kim
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Other , Korea (South) MAERAN KIM
  • - Korea University Guro Hospital , Korea (South) JINWOO HAN
  • - Korea University Guro Hospital , Korea (South) SUN HONG
  • - Seoul National University Hospital , Korea (South) YONSUB SONG
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Korea University Guro Hospital , Korea (South) Yoonmi Choi
▶ Correct Answer as Differential Diagnosis : 21/101,  20.8%
  • - Chungbuk National University Hospital , Korea (South) SOOJUNG LEE
  • - Other , Korea (South) SEONG SU KANG
  • - Soonchunhyang University Hospital Seoul , Korea (South) SUNG HWAN BAE
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Chonnam National University Hospital , Korea (South) GUNSU KIM
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Chonbuk National University Hospital , Korea (South) WON HYEONG IM
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Asan Medical Center , Korea (South) Dabi Lee
  • - Kaohsiung Veterans General Hospital , Taiwan MING-TING WU
  • - University of Utah , United States AKIHIKO SAKATA
  • - Pusan national university hospital , Korea (South) So min Park
  • - Korea University Guro Hospital , Korea (South) HWANSEOK YONG
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