대한흉부영상의학회 Weekly Chest Cases

Case No : 1118 Date 2019-04-01

Courtesy of Kyongmin Sarah Beck, MD / Seoul St. Mary’s Hospital, Catholic University of Korea
Age/Sex 62 / M
Chief Complaintincidentally found lung mass

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

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: 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,

No. of Applicants : 84

▶ Correct Answer : 17/84, 20.2%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- istanbul , Turkey AYHAN YILMAZ
- Other , Korea (South) JIYEON HAN
- Gifu University Hospital , Japan Yo Kaneko
- Seoul National University Hospital , Korea (South) JI HEE KANG
- Medicheck health care , Korea (South) Chae hun Lim
- National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Azienda Ospedaliera di Cremona , Italy Pietro Sergio
- Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
- TB centre kasaragod. , India rikhy krishnan
- Toranomon Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- Hamamatsu University Hospital , Japan YUKI HAYASHI
- Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

▶ Correct Answer as Differential Diagnosis : 13/84, 15.5%

- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- TWMU Medical Center East , Japan MASAFUMI KAIUME
- Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
- , Korea (South) HYEYOUNG CHOI
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Seoul National University Hospital , Korea (South) Ju Gang Nam
- Oita University, Faculty of Medicine , Japan Fumito Okada
- , Japan NAOMI YUASA
- Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Chonnam National University Hospital , Korea (South) BYEONGHAK SIM
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Semi-Correct Answer : 7/84, 8.3%

- Chonbuk National University Hospital , Korea (South) MINGI SHIN
- Chonbuk National University Hospital , Korea (South) EUN HA JUNG
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
- , Japan YUMI MAEHARA
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1118 Date 2019-04-01

Discussion

No. of Applicants : 84