Pulmonary sclerosing hemangioma presenting with dense spindle stroma cells: a potential diagnostic pitfall

Our plain-English summary of Pulmonary sclerosing hemangioma presenting with dense spindle stroma cells: a potential diagnostic pitfall, by X.Y. Lin, Y. Wang, C.F. Fan, et al (Diagnostic Pathology, 2012).

The study

• Authors: X.Y. Lin, Y. Wang, C.F. Fan, Y. Liu, J.H. Yu, S.D. Dai, L. Wang, E.H. Wang
• Journal: Diagnostic Pathology
• Published: 2012;7:174
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Unlabelled: Pulmonary sclerosing hemangioma (PSH) is an uncommon pulmonary tumor. Histologically, PSH typically consists of two types of cells, surface cuboidal cells and polygonal cells, four architectural patterns including papillary, sclerotic, solid, and hemorrhagic. Herein, we present a case of PSH in a 59-year-old Chinese female. The tumor was predominantly composed of solid area presenting with diffuse spindle cells rather than polygonal cells. Focally, classical papillary and sclerotic area could be seen. Immunohistochemical staining showed that the spindle cells were positive for TTF-1, EMA, Actin(SM) and Vimentin, and negative for cytokeratin, cytokeratin7, cytokeratin5/6, surfactant apoprotein A, surfactant apoprotein B, CD34, CD99, S-100, HMB45, Desmin, Synaptophysin, CD56, ALK and Calretinin. The immunophenotype of the dense spindle cells in this case was similar to that of the polygonal cells, and thus the spindle cells may be the variants of polygonal cells. Based on morphologic features and the immunohistochemical profile, the tumor was diagnosed as a PSH. The significance of spindle cells change is unclear for us. To our knowledge, this is the first reported case of PSH showing dense spindle cells in solid area. This case represents a potential diagnostic pitfall, as it may be misdiagnosed as a mesenchymal tumor such as inflammatory myofibroblastic tumor, synovial sarcoma, solitary fibrous tumor, leiomyoma, or even mesothelioma, especially if the specimen is limited or from fine- needle aspiration.

Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1235401622806126.

In plain English

This article was a case report about one patient, a 59-year-old Chinese woman who had never smoked, with an uncommon lung tumor called pulmonary sclerosing hemangioma (PSH). The article did not discuss asbestos. Mesothelioma was mentioned only as one of the tumors this case could be mistaken for. The woman came to the authors' hospital with chest pain and cough. A scan showed a single nodule in the right lung measuring 4.7×4.1 cm. She reported that a nodule of 2.7×2.0 cm had been found two years earlier. Surgeons removed the lung lobe and nearby lymph nodes. Under the microscope, the tumor was mostly made of spindle-shaped cells rather than the usual polygonal cells. Typical PSH patterns appeared only in small areas. Stains showed the spindle cells were positive for TTF-1, EMA and Vimentin, and less than 2% of tumor cells were positive for the growth marker Ki67. No lymph node spread was found. The authors concluded that using a panel of stains including TTF-1 is essential to avoid misdiagnosis, and that long-term follow-up is necessary.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 59-year-old Chinese woman with no smoking history, treated at the authors' hospital (Department of Pathology, First Affiliated Hospital, China Medical University, Shenyang, China)
• Main results:
  • A CT scan showed a solitary, well-circumscribed nodule in the lower right lung, 4.7×4.1 cm in diameter
  • The patient reported that a nodule measuring 2.7×2.0 cm had been found two years earlier during routine examination
  • The tumor was mainly composed of solid areas of diffuse spindle cells rather than polygonal cells, with classical papillary and sclerotic areas seen only focally
  • The spindle cells were diffusely positive for TTF-1, EMA and Vimentin, and focally positive for Actin(SM)
  • Less than 2% of tumor cells were positive for Ki67
  • In this patient the tumor grew slowly and no lymph node metastasis was found
  • Based on the microscopic appearance and staining, the tumor was diagnosed as PSH
• The authors' conclusion: The authors concluded that this case is a potential diagnostic pitfall that could be misdiagnosed as a mesenchymal tumor (including mesothelioma), and that using a panel of antibodies including TTF-1 is essential to avoid misdiagnosis
• Limitations the authors state:
  • The authors stated that the significance of the spindle cell change is unclear to them and that long-term follow-up is necessary

Topics

Medical terms in this study, explained in our Lexicon: Spindle Cell, Immunohistochemistry, Thyroid Transcription Factor-1 (TTF-1), CD34, S-100, Desmin, Calretinin, Mesenchymal Tumor.

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