Sixteen cases of sclerosing hemangioma of the lung including unusual presentations

Abstract

Sclerosing hemangiomas (SH) of the lung are uncommon tumors and are thought to be benign. However, the biologic behavior of this tumor has not yet been characterized adequately. The clinicopathologic features were reviewed and analyzed for 16 cases of SH. The age of the patients ranged from 37 to 73 yr (mean 50.6 yr). There were fifteen female and one male patient. The SH located at the intraparenchyme in 14 cases, the interlobar fissure in one case and the visceral pleura in one case. The size of SH ranged from 0.3 cm to 8 cm (mean 2.6 cm). There were five unusual presentations of SH including a case having two SH with multiple nodules of atypical adenomatous hyperplasia in the same lobe, a case showing adenocarcinoma-like area within the SH, a case showing one peribronchial lymph node metastasis (N1 nodal stage) with location of interlobar major fissure, a case showing alveolar adenoma-like area within the SH, and one case with a large visceral pleural-based pedunculated mass presenting as mediastinal mass. All patients were alive and well without recurrence at the last follow up. Here, we reviewed previously published literatures and discussed the histogenesis of SH.

Fig. 1

Four major histologic patterns and immunohistochemistry of the sclerosing hemangiomas. Sclerosing hemangiomas show papillary (A), solid (B), sclerotic (C), and hemorrhagic (D) patterns. Sclerosing hemangioma consists of lining cuboidal cells (A) and stromal round cells (B) (H&E stain: A, B ×200; C, ×100; D, ×1). Immunohistochemical stain shows that both lining cells and round cells are positive for TTF-1 (E) and EMA (F), and CD56 (G). The pancytokeratin (H) reacts with the lining cells and focally reacts with round cells. (E to H, ×200).

Fig. 2

Unusual presentations of the sclerosing hemangiomas. Two sclerosing hemangiomas (A, B) with atypical alveolar hyperplasia-like nodule (C) in the background lung parenchyme (H&E stain: A, B, ×1; C, ×200). Atypical alveolar hyperplasia-like nodule shows that the lining cells and some stromal cells are positive for TTF-1 (D) immunostaining (×400). (E) One sclerosing hemangioma with lymph node metastasis (H&E stain, ×200). (F) One sclerosing hemangioma with an alveolar adenoma-like area in the upper half (H&E stain, ×100). (G) One sclerosing hemangioma with adenocarcinoma-like area (H&E stain, ×100).