Sclerosing pneumocytoma

Khanna, Aakanksha; Alshabani, Khaled; Mukhopadhyay, Sanjay; Lam, Louis; Ghosh, Subha

doi:10.1097/md.0000000000015038

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…A large series from Shanghai suggests that PSP are most commonly found in middle age (40-70 years) females that are nonsmokers (3). The mass was more typical in terms of its location and less commonly PSP's can arise from pulmonary hilar region (4) or even have an endobronchial location (5). Whilst most typically present as a solitary peripheral nodule as we report here, rare cases with multiple PSP lesions have been reported (6).…”

Section: Discussionmentioning

confidence: 71%

Robotic excision of pulmonary sclerosing pneumocytoma: a case report

Smith¹,

Mason²,

Duvva³

et al. 2021

AME Surg J

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We report the first excision of pulmonary sclerosing pneumocytoma (PSP) via a robotic approach. A 20-year-old Caucasian male presented with an incidental 48 mm mass in the right lower lobe. CT-guided biopsy was performed achieving a pre-operative diagnosis of PSP, previously known as pulmonary sclerosing hemangioma. A key histological feature of PSP is the presence of both cuboidal surface cells and stromal round cells and this results in a challenge in diagnosing them on frozen section where they can be easily mistaken for adenocarcinoma or carcinoid tumours. With most PSPs typically presenting as a solitary peripheral nodule, the differential diagnosis is wide. On CT, a predominantly smooth boundary and oval shape is common. The varying proportions of the haemangiomatous, papillary, sclerotic and solid histological patterns result in varying density of 96 to 157 Hounsfield Units, with higher attenuation in angiomatous, isoattenuation in solid and sclerotic and low attenuation in cystic areas. The most common CT signs are a marginal pseudocapsule (50%), overlying vessel (26.3%), halo sign (17.1%) and air-gap sign (2.6%).PSPs also frequently exhibit the tail sign on CT. When one or more of these signs are present, clinicians should be more alert to the possibility of PSP. The majority of reports suggest that PSPs are hypo or intermediate grade lesions on PET. A robotic right lower lobectomy was successfully performed in this case and allowed for the early discharge of the patient and a return to usual activities within 3 weeks. Minimally invasive thoracic surgery via a robotic approach is beneficial to both young, fit patients and may be also advantageous in those with poor lung function or multiple co-morbidities. The challenge with such cases is often with obtaining the correct preoperative radiological and histological diagnosis. Whilst no follow-up guideline for these rare tumours exists, in view of reported malignant potential we advocate close follow-up of patients.

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Section: Discussionmentioning

confidence: 71%

Robotic excision of pulmonary sclerosing pneumocytoma: a case report

Smith¹,

Mason²,

Duvva³

et al. 2021

AME Surg J

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“…Radiological findings can support the diagnosis. PSPs, in fact, present as a peripheral, solitary, well-defined mass, more frequently located in the lower lobes, with overlying vessels (26.3% of cases) [ 4 ] and surrounding ground-glass opacities [ 5 ]. FDG PET/CT scan has demonstrated a low to moderate uptake in PSPs.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-operative diagnosis, when feasible, is helpful to plan the best therapeutic strategy. It is well known that PSP is characterized by two different cell populations, surface and round stromal cells, typically organized in four architectural patterns: papillary, sclerotic, solid and hemorrhagic [ 5 , 6 , 7 , 8 , 9 ]. The cytological features parallel these major histological patterns; at least two (more frequently the papillary and solid patterns) of the four architectural patterns occur in all patients, and three of the patterns are found in 95% of patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Sclerosing Pneumocytoma: A Pre and Intraoperative Diagnostic Challenge. Report of Two Cases and Review of the Literature

et al. 2021

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Pulmonary sclerosing pneumocytoma is a rare benign pulmonary tumor of primitive epithelial origin. Because of the unspecific radiological features mimicking malignancies and its histological heterogeneity, the differential diagnosis with adenocarcinoma and carcinoid tumors is still challenging. We report our experience of two cases of sclerosing pneumocytoma, as well as a review of the literature. Immunohistochemical findings showed intense staining of the cuboidal epithelial cells for cytokeratin-pool and TTF-1, with focal positivity for progesterone receptors. Round and spindle cells expressed positivity for vimentin, TTF-1 and focally for the progesterone receptor. Cytologic diagnosis of pulmonary pneumocytoma requires the identification of its dual cell population, made up of abundant stromal cells and fewer surface cells. Since the pre- and intraoperative diagnosis should guide surgical decision making, obtaining a sufficient specimen size to find representative material in the cell block is of paramount importance.

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“…The histopathologic examination is the gold standard for a PSP diagnosis. PSPs have the typical characteristics in microscopic morphology, consisting of two epithelial cell types, including surface cells and round cells; and microscopic architectural patterns composed of up to four varieties in each tumor, including an angiomatous variety, sclerotic stroma, papillary structure, and a solid area of tumor cells [2,20]. All PSP lesions were represented by at least two of these architectural patterns, and 95% contained no less than three of these patterns [21].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the F-18 FDG PET/CT features of pulmonary sclerosing pneumocytoma

Liu

Dang

Wang

et al. 2021

Nuclear Medicine Communications

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Purpose This retrospective study aimed to analyzed the F-18 fluorodeoxyglucose PET/computed tomography (F-18 FDG PET/CT) features of pulmonary sclerosing pneumocytoma (PSP) to improve the understanding and preoperative diagnostic efficacy of this rare disorder. Methods FDG PET/CT images from 11 patients with 22 lesions (including one patient with 12 lesions) proven PSP in our hospital were reviewed. We summarized the PET/CT features of PSP and analyzed the correlation between FDG uptake and tumor size. Results PET/CT imaging revealed all tumors located in each lobe of the two lungs randomly. All 22 tumors were round or oval nodules; 15 had smooth margins, six were lobulated, six were calcified, and one had a ground-glass halo sign. The mean diameter of these tumors was 19.2 ± 7.8 mm (range: 8–34 mm); the mean maximum standardized uptake value (SUVmax) was 2.8 ± 1.3 (range: 1.1–7.4). Sixteen of the lesions exhibited mild to moderate FDG uptake (mean SUVmax 2.3 ± 0.6), and six of the lesions exhibited intense FDG uptake (mean SUVmax 4.3 ± 1.6). A positive correlation was observed between FDG uptake and tumor size (P <0.05). Conclusion Single round or ovoid soft-tissue lesions with smooth margins, and mild to moderate FDG uptake on PET/CT images in middle-aged females, suggest a possible diagnosis of PSP. For some atypical cases with intense FDG uptake, a diagnosis of PSP also can be considered. A statistically significant positive correlation was found between SUVmax and PSP lesion size in our study.

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Sclerosing pneumocytoma

Cited by 10 publications

References 20 publications

Robotic excision of pulmonary sclerosing pneumocytoma: a case report

Robotic excision of pulmonary sclerosing pneumocytoma: a case report

Pulmonary Sclerosing Pneumocytoma: A Pre and Intraoperative Diagnostic Challenge. Report of Two Cases and Review of the Literature

Analysis of the F-18 FDG PET/CT features of pulmonary sclerosing pneumocytoma

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