Diagnosis of sclerosing hemangioma of lung: Don′t rely on fine-needle aspiration cytology diagnosis alone

Abstract

Sclerosing hemangioma is a rare variety of benign pulmonary neoplasm. It usually presents as asymptomatic, solitary, peripheral, circumscribed lesions in middle-aged women. Here, we describe a 46-year-old woman presenting to us for evaluation of right parahilar lung mass. Previous chest radiography done 10 years back showed a lung mass of almost similar size. Computed Tomography (CT)-guided fine-needle aspiration cytology (FNAC) was suggestive of adenocarcinoma of lung. A well-circumscribed, capsulated, ovoid mass measuring 5.6 cm × 4 cm × 3 cm, adjacent to the transverse fissure of the right lung was excised by lateral thoracotomy. Histopathological examination along with immunohistochemistry was suggestive of sclerosing hemangioma of lung. A pathologist must consider the clinicoradiological features before coming to a final diagnosis of lung malignancy from FNAC. Whenever there is any confusion regarding lung mass, thoracotomy must be done for arriving at an exact diagnosis from histopathology.

Sclerosing hemangioma: A diagnostic dilemma in fine needle aspiration cytology

“…[ 10 13 ] Many of these cases were misdiagnosed because the broad spectrum of morphologic patterns seen in this lesion can closely mimic a number of other epithelial and mesenchymal tumors. [ 2 6 7 8 9 10 11 12 13 14 15 ] The diagnosis of sclerosing hemangioma on FNA depends on the identification of fibrovascular stromal fragments with papillary architecture and a dual cell population. The dual cell population includes bland-appearing round cells associated with fibrotic or hyalinized stromal fragments and small groups or sheets of surface cells with pneumocyte II features arranged in pavement-like fashion.…”

“…These cells may show varying degrees of atypia and intranuclear pseudoinclusions. [ 7 8 10 13 14 ] However, well-differentiated adenocarcinoma/bronchioloalveolar carcinoma usually occurs in an older age population. The FNA is usually more cellular with crowded clusters, sheets and many single-lying atypical cells.…”

“…There are no large studies, but only isolated case reports regarding the cytologic diagnosis of sclerosing hemangioma, which show that it is often misdiagnosed on fine needle aspiration (FNA) specimens. [ 2 6 7 8 9 10 11 12 13 14 15 ] We herein describe a case of sclerosing hemangioma diagnosed on FNA with immunohistochemistry performed on accompanied cell block and review the clinicopathologic findings of this neoplasm.…”

A Challenge

“…PSHs are very difficult to identify only by chest CT. PSHs are often misdiagnosed as lung cancer, inflammatory pseudotumor, hamartoma, and other lung diseases because there is little information and image data about it. [ 3 ] The gold standard for diagnosis of this disease is pathological evidence. However, pathologic results can also cause misdiagnosis.…”

“…Saha et al . [ 3 ] reported a case of PSH that was misdiagnosed as lung adenocarcinoma relying on fine-needle aspiration cytology.…”