대한흉부영상의학회 Weekly Chest Cases

Case No : 1035 Date 2017-08-28

Courtesy of Jihang kim, MD, Junghoon Kim, MD / Seoul National University Bundang Hospital
Age/Sex 70 / F
Chief Complaintincidental finding on health screening

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary sclerosing pneumocytoma
Radiologic Findings: Chest radiograph (Fig 1) shows a well-defined small nodule in right lower lung field.
Axial chest CT images (Fig 2-4) show 2.8 cm oval, well-defined enhancing nodule in RLL. The contrast-enhanced axial image shows a subtle enhancing high attenuated rim, defined as the 'marginal pseudocapsule sign'. Enhancing vascular structure is observed at the edge of the nodule extending toward the hilum of the lung. It was defined as the 'overlying vessel sign'. The axial CT image with lung window setting shows a mass with surrounding GGO, defined as the 'halo sign'. Compared with previous CT obtained 5 years ago (Fig 5, 6), the tumor shows slow growth in size.
The patient underwent core-needle biopsy for the mass. 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. It 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. 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.
Please refer to: Case 1023 Case 730 Case 540 Case 401 Case 318 Case 268 Case 168 Case 148 Case 142
Keywords: Lung, Pulmonary sclerosing pneumocytoma, Marginal pseudocapsule, Overlying vessel sign, Halo sign, Sclerosing Hemangioma

No. of Applicants : 95

▶ Correct Answer : 43/95, 45.3%

- Toranomon Hospital , Japan SHOHEI FUJITA
- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- Gifu University Hospital , Japan TOMOHIRO ANDO
- Kyeongpook National University Hospital , Korea (South) CHUNGEUN LIM
- Other , Korea (South) SEONG SU KANG
- Asan Medical Center , Korea (South) HYUN JUNG KOO
- 罹stanbul , Turkey AYHAN YILMAZ
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- The Jikei university , Japan TAKU GOMI
- Kyungpook national university hospital , Korea (South) Nari Jung
- Ajou University School of Medicine , Korea (South) YOOLIM BAEK
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Seoul National University Hospital , Korea (South) HYOUNG IN CHOI
- Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
- Chonnam National University Hospital , Korea (South) JONG HYEON KIM
- Asan Medical Center , Korea (South) JOOAE CHOE
- Gifu University Hospital , Japan Yo Kaneko
- Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
- Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
- Samsung Medical Center , Korea (South) MIN YEONG KIM
- Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
- Medicheck health care , Korea (South) Chae hun Lim
- National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
- 怨紐 , Korea (South) jin young kim
- Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
- University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
- Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Other , Korea (South) HAYEON LEE
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
- Wuhan Union Hospital , China QIGUANG CHENG
- The University of Tokyo Hospital , Japan TAKU TAJIMA
- MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
- MacKay Memorial Hospital, Taipei , Taiwan SHENG-YEH SHEN
- Katoh-gazou-shindan , Japan SHOICHI KATOH
- Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 12/95, 12.6%

- Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
- Niigata University , Japan ATSUSHI UEHARA
- The University of Tokyo Hospital , Japan Yusuke Watanabe
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Yeungnam University Medical Center , Korea (South) MINJUNG RYU
- Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
- Azienda Ospedaliera di Cremona , Italy Pietro Sergio
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- District TB centre, kasaragod,India , India rikhy krishnan
- Fortis hospital , Mohali , India SHALEEN RANA
- Seoul National University Hospital , Korea (South) YONGSUB SONG
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1035 Date 2017-08-28

Discussion

No. of Applicants : 95