Cytopathologic diagnosis of pulmonary sclerosing hemangioma

Abstract

There are many reports of sclerosing hemangioma from the perspective of its histopathologic features, but its cytopathologic characteristics are less well known. In this report we present the case of a patient in which the cytologic features firmly established a definitive diagnosis; surgical intervention was warranted only after the lesion had grown over the course of 7 yr of close observation. The cytologic diagnosis requires the identification of a dual cell population. Both populations of tumor cell nuclei are immunoreactive for thyroid transcription factor-1, but caution is warranted because this marker may be present in other tumors. Recognition of its distinctive cytologic features can lead to proper diagnosis and conservative management.

Pitfalls and Key Features of a Case of Sclerosing Pneumocytoma: A Cytological Challenge?

“…The cytopathological diagnosis of SP can be difficult and challenging because the clues and the diagnostic pitfalls are not well understood. In fact, there are only few reports in the worldwide literature which have investigated the cytopathological features of this tumour [6,7,8,9,10]. In our experience, the typical key features of SP are the presence of an abundant dual population of polygonal type II pneumocytes and spindle cells, cohesive papillae, clusters or flat sheets lined by medium/large-sized cells.…”

“…Moreover, areas of neoplastic clear cells can be confused with metastasis from renal cell carcinoma, but the characteristic morphology and pleomorphism of the nuclei and frequent mitotic figures with the clinical history can easily address the correct diagnosis. In addition, if nuclear atypia is present discrimination between the morphology of an SP and the characteristics of a well-differentiated adenocarcinoma can be problematic, though in SP the nuclei typically lack nucleoli and this could be considered a useful discriminating feature [6,7,8,9,10,11]. Differentiation from reactive changes, tuberculosis and other adenomas such as the so-called ‘sugar tumours' can be difficult to estimate due to the heterogeneous growth pattern and the bland morphology of the cells; therefore, a clinical and radiological correlation is essential.…”

“…Moreover, the tumour shows a strong expression of TTF-1 that is typically present also in adenocarcinoma. Therefore, the cytopathological diagnosis can be very challenging and difficult to perform and the lesion can be misdiagnosed as a malignant tumour [7,8,9,10]. However, identifying the key features for a correct cytopathological diagnosis could be a precious tool for a less aggressive diagnostic approach and a conservative surgical treatment.…”

Endobronchial variant of sclerosing hemangioma of the lung: histological and cytological features on endobronchial material

“…[3][4][5][6][7][8][9][10][11] A dual cell proliferation of round cells and pneumocytes associated with numerous foamy macrophages is the hallmark of the lesion. Round cells arranged in clusters have a characteristic cytologic appearance, with small, uniform nuclei, inconspicuous nucleoli and scant cytoplasm.…”

Cytologic Features of Benign Solitary Pulmonary Nodules with Radiologic Correlation and Diagnostic Pitfalls

“…Rare case reports and a few small series describe the cytology of SH on FNAB. [31][32][33][34][35] In these reported cases, the smears show abundant cellular material consisting of round to cuboidal cells arranged in solid or papillary, flat, pavement-like cell patterns. The cells have clear or granular eosinophilic cytoplasm and uniform nuclei with occasional intranuclear inclusions.…”