Multiple peripheral typical carcinoid tumors of the lung: associated with sclerosing hemangiomas

Abstract

This study presents a first case of multiple peripheral typical carcinoid tumors associated with sclerosing hemangiomas in the lung. A 52-year-old male presented with incidentally detected multiple pulmonary nodules on a simple chest X-ray during routine health check-up. A computed tomography (CT) scan of the chest showed multiple nodular lesions in the middle and lower lobes of the right lung. These were initially suspected as inflammatory lesions due to miliary tuberculosis. However, possibility of malignancy could not be excluded and right lower lobe lobectomy was performed. Histopathologically, some nodules including two largest nodules were composed of small round to spindle shaped cells with fine chromatin pattern, whereas the rest of the sclerotic nodules were composed of two epithelial cell types- surface cells and round cells. The final diagnosis of this case was multiple peripheral typical carcinoid tumors associated with sclerosing hemangiomas of the lung. For past three years of post-surgery follow up period, no new lesions or changes in the right middle lobe have been identified.

Figure 1

Preoperative chest computed tomography. (A, B) CT shows numerous nodules with some calcifications in the right middle and lower lobes.

Figure 2

Postoperative macroscopic examination of the lung. On gross examination, the tumors were white to pink in color, variable in size, with some calcifications and hemorrhages. They were well circumscribed round shaped tumors without fibrous capsule. The arrows indicate carcinoid tumors.

Figure 3

Postoperative microscopical findings of lesion in the carcinoid portion. (A) The tumor showed trabecular arrangement. (B) The tumor composed of monotonous small ovoid to spindle cells with “salt-and pepper” chromatin pattern without mitosis. The tumor cells were positive for CD56 (C), synaptophysin (D), chromogranin (E), but negative for TTF-1 (F). (A. Original magnification of H&E staining at 20 X; B. Original magnification of H&E staining at 400 X; C-F. Original magnification of immunohistochemical staining at 200 X).

Figure 4

Postoperative microscopical findings of lesion in the PSH portion. (A, B) The tumor shows papillary structures which are composed of hyalinized stalks lined with surface cuboidal cells which shows mild atypical nuclei with vacuolated and foamy cytoplasm. The sclerosing lesion contained round cells with uniform nuclei with pale, eosinophilic or clear cytoplasm. (C) On immunohistochemical stain, surface cuboidal cells were positive for pancytokeratin but round cells were negative for it. Both surface cuboidal cells and round cells were positive for TTF-1 (D) and negative for synaptophysin (E) and chromogranin (F). (A. Original magnification of H&E staining at 20 X; B. Original magnification of H&E staining at 400 X; C-F. Original magnification of immunohistochemical staining at 400 X).