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					Diagnosis of fine needle
  aspiration cytology
      Atypical glands
Diagnosis of frozen section

       adenocarcinoma
Pathological diagnosis
  Sclerosing hemangioma
Final pathological diagnosis

Sclerosing hemangioma of lung with
       lymph node metastasis
  Sclerosing hemangioma of lung:
             definition
• An unusual benign tumor originally
  decribed by Liebow and Hubbell in 1956
• They thought that the prominent vascular
  lakes or hemorrhagic areas were actually
  vasular spaces.
• Postinflammatory pseudotumor,
  histiocytoma, fibroxanthoma, papillary
  pneumocytoma
  Nature of sclerosing hemanigoma of lung

• Neoplastic, or hamartomatous, or reactive?
• Origin:
   –   Endothelial
   –   Mesothelial
   –   Epithelial
   –   Mesenchymal
   –   An epithelial origin ( type II pneumocyte ) has been
       supported by immunohistochemical and EM studies.
  Monoclonality of SHs of lung

• SHs show monoclonal expansion
  (neoplastic ).
• Two major cell types show an identical
  monoclonal pattern.
• Both cell types are neoplastic and originate
  from one cell, subsequently undergoing
  differentiation to heterogenous
  histiopathogical findings.
                         Am J Pathol 1998;152;1065-1069
              Clinical features
•   >80% are female
•   Average age is 44 years ( 15 to 83 years )
•   Most patients are asymptomatic ( >70% )
•   Symptoms
    – Cough, chest pain, hemoptysis, flu-like
• CxR:
    – Solitary, rarely multiple, circumscribed mass
Dx. of images and bronchoscopy
• Radiographic manifestations:
  – CT scan
     • Accurate diagnosis of SH: 20% ( 4/20 )
     • Malignancy: 40%
     • Others: hamartomas, TB, other benign lesions
  – Bronchoscopy: 25 cases
     • Biopsy: chronic inflammation or fibrosis
     • Cytology: no abnormal cell
                             J Chin Med Assoc 2003; 66:33-8
             Histologic findings
• Average 2.8 cm in size ( 0.4 to 8.0 cm )
• 2 types of cells
   – Polygonal cells: primitive respiratory epithelium
   – Cuboidal cells: mature pneumocytes or clara cells
• 4 major histologic patterns
   –   Solid
   –   Papillary
   –   Sclerotic
   –   hemorrhagic
 Overdiagnosis in frozen section
• Although SH is a well-documented benign
  tumor, it is sometimes misdiagnosed as a
  malignant lesion, especially in
  intraoperative frozen sections because of its
  variable histologic elements.
  – Adenocarcinoma
  – Angiosarcoma
• Rough incidence: 10% ( 3/31)
        Multifocal SH of lung
• 4% to 5% of all SH cases.
• In same lobe, or in ipsilateral lung, or in
  both lungs
• Primary tumor multicentric origins, or
  multiple intrapulmonary areogenic or
  transbronchial metastases?
 SH isolated to the mediastinum
• 3 plausible mechenisms:
  – Metastasis from the lung to mediastinum
    ( especially in cases >3.5-cm tumor size )
  – From ectopic lung tissue in mediastinum
  – Developed from the lung as a pedunculated
    pleural mass that slowly pulled away from the
    lung surface
                           Ann Thorac Surg 2003;75:1021-3
       SH with LN metastasis
• A rough incidence: 2% to 4%
• Till now, 9 cases were reported in literature.
• Its significance is not clear.
• Prognosis did not appear to be affected by
  the presence of regional lymph node
  metastases.
• Although benignity, an evaluation of LN
  metastasis is suggested.
  Sex hormone receptors of SHs
• Estrogen receptor
  – 2/28 in round cells ( female )
• Progesterone receptor
  – 17/28 in round cells
  – F:M=15:2
                        Am J Surg Pathol 2000;20(7):906-916
      Treatment and prognosis
• Surgical excision is curative.
  – Wedge resection or enucleation
  – Lobectomy: for
     • Larger tumor size
     • Central location
     • A RML tumor
• Prognosis is excellent.
    Classical clinical manifestations
•   A middle-aged patient
•   Female
•   No symptom
•   Incidental finding by CxR
•   Single, well-circumscribed mass

				
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posted:4/21/2013
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