Solitary pulmonary capillary hemangioma presents as ground glass opacity on computed tomography indicating adenocarcinoma in situ/atypical adenomatous hyperplasia: A case report

Abstract

Solitary pulmonary capillary hemangioma (SPCH) is a rare type of benign lung tumor, which must be distinguished from early lung cancer and precancerous lesions of the lung that manifest in a similar way upon imaging. The current study describes a case of SPCH and a review of the literature is performed. The patient was a 40-year-old Chinese woman who was referred to the Liaoning Cancer Hospital and Institute (Shenyang, China) in October, 2015 with a cough without obvious inducement. Computed tomography (CT) demonstrated pure ground glass opacity (GGO) in the right upper lung. Following systemic anti-inflammatory therapy over 6 months, the lesion did not exhibit any change on CT and was suspected to be an adenocarcinoma in situ (AIS) or atypical adenomatous hyperplasia (AAH). Video-assisted thoracic surgery wedge resection was subsequently performed. Frozen section diagnosis revealed a benign tumor without atypical epithelial cells. Subsequent to surgery, paraffin sections demonstrated that the tumor contained narrow alveolar cavities, thickened alveolar septa and a clear boundary separating it from healthy lung tissue. Furthermore, the proliferation lumens in the alveolar septa were lined with a single layer of flat cells. Immunohistochemical staining revealed that the flat cells were positive for cluster of differentiation CD31 and CD34, and negative for thyroid transcription factor-1 and cytokeratin. The proliferation of capillary vessels lead to the thickened alveolar septa and the tumor was diagnosed as SPCH. When imaging examination demonstrates a GGO in lung, SPCH must be considered in the differential diagnosis of AIS/AAH. As the prognosis of these lesions is entirely different, a pathological examination must be conducted to ensure a correct diagnosis.

Solitary Pulmonary Capillary Hemangioma: CT and PET-CT Features with Clinicopathologic Correlation

“…SPCH was first described in the literature as “pulmonary capillary hemangiomatosis-like foci” in 2000, in a report of eight autopsies [ 2 ]. Unlike pulmonary capillary hemangiomatosis, which is closely related to pulmonary hypertension and poor prognosis [ 5 , 6 , 7 , 8 ], SPCHs often present as an incidental solitary pulmonary nodule with excellent prognosis [ 1 , 3 , 4 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

Solitary pulmonary capillary hemangioma presenting with a ground glass opacity: A case report & literature review

“…SPCH is difficult to diagnose because of a lack of typical symptoms. Radiographic findings often include pure or mixed GGOs, which may lead to suspicions of adenocarcinoma in situ (AIS), atypical adenomatous hyperplasia, and focal inflammation [ 2 , 6 ]. In their case series, Zhao et al summarized 9 surgically resected cases of SPCH.…”

Radiomic Feature Analysis for Distinguishing Solitary Pulmonary Capillary Hemangioma From Lepidic-Predominant Lung Adenocarcinoma in Ground Glass Lung Nodules

“…However, the nal diagnosis of these indeterminate lung nodules includes not only malignancies but also benign lung tumors [16]. SPCH has been an uncommon benign lung tumor, with only 17 reported cases of surgically resected SPCH before 2018 [1,[3][4][5][6][7][8][9][10][11]. However, 25 more cases have been reported in the last two years [12,13].…”

“…The increasing incidence of this benign tumor raised the importance of preoperative diagnosis. However, SPCH is characterized by GGNs in CT images and mimics LPA radiographically [1,[3][4][5][6][7][8][9][10][11][12][13]. Even experienced thoracic surgeons and radiologists may regard SPCH as early primary lung cancer.…”

“…This uncommon disease was rst described in a report of eight autopsies in 2000 as "pulmonary capillary hemangiomatosis-like foci" [2], and the term SPCH was rst used in a report of two surgically resected patients in 2006 [3]. Only 17 cases of surgically resected SPCH have been reported in the English literature before 2018 [1,[3][4][5][6][7][8][9][10][11]. Clinically, SPCH usually presents as a ground-glass nodule (GGN) on chest computed tomography (CT) images, which is similar to the presentation of adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidicpredominant adenocarcinoma (LPA) of the lung [1,[3][4][5][6][7][8][9][10][11][12][13].…”