Pulmonary sclerosing hemangioma: pitfalls in management

Abstract

Pulmonary sclerosing hemangioma is a rare benign tumor for which surgical excision is curative with an excellent prognosis. It often mimics malignancy, making it a diagnostic and management challenge. We reviewed the clinical, radiological, and histopathological characteristics as well as the surgical management of our patients to assess the potential pitfalls in management. All 19 patients who underwent surgical biopsy between January 1999 and December 2009 with a final histopathological diagnosis of pulmonary sclerosing hemangioma were reviewed retrospectively. The median age was 48 years, 89.5% were female, 89.5% were Chinese, and 68.4% were asymptomatic. There were no specific diagnostic radiological characteristics; 1 of 3 patients who underwent combined positron-emission and computed tomography had a false-positive result. Preoperative attempts at establishing a diagnosis were successful in 20% of patients who had invasive procedures. Intraoperative frozen-section evaluation for pulmonary sclerosing hemangioma had an error rate of 25% and a deferred rate of 31%, resulting in nearly half of our patients undergoing unnecessary extensive surgical procedures. We hope to heighten awareness of this diagnosis, thereby increasing the index of suspicion and minimizing errors in diagnosis.

Pulmonary sclerosing pneumocytoma presenting as slow-growing multiple nodules over a long period

“…The radiologic findings for the tumors included in the differential diagnosis show similar sharply marginated single or multiple nodules, so histopathologic analysis is required to make a correct diagnosis of PSP. The pathologic features required for a definitive diagnosis of PSP are well known; however, a correct clinical diagnosis by biopsy is often difficult and PSP is frequently misdiagnosed as bronchioloalveolar adenocarcinoma, metastatic papillary thyroid carcinoma, carcinoid tumor, or mesothelioma if the papillary structure is predominant in the biopsy specimens [2], [3], [4], [17]. Iyoda et al [4] reported that only 7 of 26 patients with PSP were diagnosed preoperatively by percutaneous needle or transbronchial biopsy.…”

“…Iyoda et al [4] reported that only 7 of 26 patients with PSP were diagnosed preoperatively by percutaneous needle or transbronchial biopsy. Low et al [2] reported that PSP is often misdiagnosed, even by assessment of an intraoperative frozen section, with an error rate of 25% and a deferred rate of 31%; these rates are higher than those for lymphoma and carcinoid tumor. They also warned that misdiagnosis may result in unnecessarily extensive surgical procedures and potentially an increase in the associated morbidity.…”

“…PSP generally presents as a solitary well-defined mass, and presentation with multiple nodules is rare. The histopathologic characteristics of PSP are well known; however, PSP is often misdiagnosed as another type of tumor or malignancy on preoperative biopsy and even on assessment of an intraoperative frozen section [2], [3], [4]. Here we present a case of multiple PSP in a young woman that was difficult to diagnose on percutaneous biopsy.…”

Correlation Between Pulmonary Sclerosing Pneumocytoma Features and MSCT Imaging Manifestations in 34 Patients: Implications for Precision Medicine

“…Internal features of tumors on MSCT were evaluated using the image analyses. According to the net increased CT value, that was, the absolute value of the difference between the CT values of enhanced scan and the plan scan, referring to the Swensen standard (26), it was divided into a non-enhanced area (increased CT value <15 Hu), a marginally enhanced area (CT value increased by 15-25 Hu), a moderately enhanced area (CT value increased by 25-45 Hu), and a significantly enhanced area (CT value increased by> 45 Hu).…”

Pulmonary sclerosing pneumocytoma remains a diagnostic challenge using frozen sections: a clinicopathological analysis of 59 cases

“…The different immunohistochemical profiles can aid in diagnosis, especially in needle biopsies. However, during time‐limited intraoperative frozen section (FS) examinations, it is always challenging to make correct diagnoses . In this study, our aim was to identify the growth patterns that are easily misdiagnosed and the possible diagnostic pitfalls of using FSs.…”