Sclerosing Hemangioma of the Lung(pneumocytoma) 肺血管瘤(肺泡瘤).pdf

Sclerosing Hemangioma of th Lung (SHL) Archives of Pathology_2009 Contents • Clinical features • Gross features • Radiologic features • Histopathology • Ancillary studies • Differential diagnosis • Current treatment and prognosis Clinical features • middle-aged adults • female to male, 5:1.5 • Most Pts: asymptomatic (CXR) • Symptomatic Pts: − hemoptysis − chronic cough − chest pain • Lymphatic metastasis rarely seen Gross features • Location: − In the peripheral lung − lung parenchyma(majority) • Well-circumscribed, yellow-tan masses • Solitary • d: 0.3 to 7 cm •Typically: solid and firm (areas of hemorrhage not uncommon) Radiologic features • CXR: peripheral, solitary, well-defined, homogeneous(均质的) nodule or mass without predilection(偏好) for a particular lobe • Enhanced CT: • round to oval nodule or mass • smooth margins • Calcification evident on CT • Non-specific but benign lesions • PET-CT: indeterminate lesions CXR CT Coexistence of pulmonary sclerosing hemangioma and primary adenocarcinoma in the same nodule of lung Histopathology • Morphologically distinct: • 2 epithelial cell types: surface cells and round cells − Surface cells: cuboidal and resemble reactive type II pneumocytes. − Round cells: small with well-defined borders, fine chromatin, and inconspicuous nucleoli • 4 architectural patterns: papillary, sclerotic, solid, and hemorrhagic • Bronchial washings, fine-needle aspiration Differential diagnosis • Well-differentiated adenocarcinoma • Carcinoid carcinoma • Hemartoma • Metastatic carcinoma Treatment and prognosis • surgical excision • No need for additional treatment. • Prognosis: good • Rare lesions: regional lymph node metastasis; no influence on prognosis.