대한흉부영상의학회 Weekly Chest Cases

Case No : 148 Date 2000-08-26

Courtesy of Kyung Soo Lee, MD. / Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
Age/Sex 43 / F
Chief ComplaintIncidental solitary pulmonary nodule on chest radiograph

Figure 1
Figure 2
Figure 3

Diagnosis With Brief Discussion

Diagnosis: Sclerosing Hemagioma with a small portion of Adenocarcinoma
Radiologic Findings: CT scans show a 2-cm-sized, peripheral, enhancing nodule with surrounding halo of ground-glass attenuation in left lingular division.

Percutaneous fine needle aspiration showed clusters of adenocarcinoma.
Pathologic specimen of left upper lobectomy showed well-differentiated adenocarcinoma (0.4 cm) in background of sclerosing hemangioma (1.3 cm)(=papillary pneumocytoma) with peritumoral hemorrhage.
Brief Review: Sclerosing hemangioma (=papillary pneumocytoma) is a rare benign tumor of the lung with controversial histogenesis and first described by Liebow and Hubbell in 1956.
There is a female-to-male predominance of approximately 4 to 5:1, a gender difference that may be related to the presence of estrogen receptors in some tumors.
Most lesions are discovered in patients between 30 and 50 years of age.

Most cases were asymptomatic, but some presented with 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.
They are usually well-defined, circumscribed, hemorrhagic nodules.
The tumor is often subpleural, and a thin fibrous pseudocapsule separates it from the adjacent compressed lung parenchyma.

Four pathologic patterns are recognized: solid, hemorrhagic, papillary, and sclerotic.
There were a mixture of at least three of these patterns, and a solid area was present in all cases.

On CT, sclerosing hemangioma appeared as well defined juxtapleural masses in all cases.
The tumors enhanced by visual criteria in all but one patient with the smallest mass.
The CT density of the enhancing mass ranged from 96 to 157 HU.
Some patients had calcifications and a few had well defined areas of low attenuation, corresponding with angiomatous, solid and sclerotic, and cystic areas, retrospectively.
References: 1. Im JG, Kim WH, Han MC et al. Sclerosing hemangioma of the lung and interlobar fissures: CT findings. Journal of Comput Assist Tomogr 1994; 18(1):34-38.
2. Armstrong
3. Spencers lung
Keywords: Lung, Benign tumor,

No. of Applicants : 32

▶ Correct Answer : 15/32, 46.9%

- 嫄닿뎅
- 怨
- 源
- 留臾멸린
- 諛李쎈
- 源
- 二쇱
- 沅
- Gachon Medical School Gil Medical Center Seo Joon Beom
- Ospedale di Fabriano, Italy Giancarlo Passarini
- Sakuragaoka, Kagoshima city, Kagoshima, Japan Yasutaka Baba
- Seoul City Boramae Hospital Jae-Woo Song
- Seoul National University Hospital Kim Hyo-Cheol
- Seoul National Universtiy Hospital Huyck-Jae Choi
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate

▶ Semi-Correct Answer : 9/32, 28.1%

- 嫄곗갹
- 遺理湲곕났
- 沅寃쎌
- 吏二쇨
-
- 源
- CHU Nancy-Brabois, Vandoeuvre les Nancy cedex, France Denis REGENT
- Dong-A university hospital, Pusan Ki-Nam Lee
- Matsuyama Red Cross Hospital, Matsuyama, Japan Shunya Sunami

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 148 Date 2000-08-26

Discussion

No. of Applicants : 32