Sclerosing hemangioma of the lung showing strong FDG avidity on PET scan: Case report and review of the current literature

Abstract

Sclerosing Hemangioma is a rare lung tumor with polymorphic histologic features that usually occurs in middle aged women. Based on many immunohistochemical and ultrastructural studies, it is most probably derived from undifferentiated respiratory epithelial cells. Symptoms are usually due to enlargement of the tumor and compression of the surrounding tissues. Occurrence of multiple lesions or metastasis is extremely rare although some authors consider sclerosing hemangioma as a potentially low grade malignancy tumor. It usually presents with low to moderate uptake on FDG PET imaging. We present a case of sclerosing hemangioma with strong FDG avidity on PET scan in a 41 year old lady with history of haemoptysis. A full review of the literature on this topic was performed.

Keywords: Lung; PET avidity; Sclerosing hemangioma.

Fig. 1

Sclerosing Pneumocytoma (H&E). Well circumscribed non encapsulated intrapulmonary tumour compressing the adjacent lung parenchyma, showing papillaroid, sclerotic, solid and angiomatoid areas. There are no areas of necrosis. (a) Sclerosing pneomocytoma (H&E X12.5 Magnification) Well circumscribed unencapsulated haemorrhagic intrasclerosing mass. (b) Sclerosing pneumocytoma (H&E X100 Magnification) Sclerotic and papillaroid areas. (c) Sclerosing pneumocytoma (H&E X100 Magnification) Hypercellular areas. (d) Sclerosing pneumocytoma (H&E X100 Magnification) Angiomatoid and haemorrhagic areas. (e) Sclerosing pneumocytoma (H&E X200 Magnification) Papillaroid areas.

Fig. 2

Sclerosing Pneumocytoma (Immunohistochemistry). AE1/AE3 highlights the presence of a rim of cells lining the angiomatoid and papillaroid areas and a second population of cells found in the intervening spaces which are AE1/AE3 negative. Both cellular components express EMA and TTF-1. (a) Sclerosing Pneumocytoma AE1/AE X100 Magnification. (b) Sclerosing Pneumocytoma EMA X100 Magnification. (c) Sclerosing Pneumocytoma TTF-1×100 magnification. (d) Sclerosing Pneumocytoma CD34×100 Magnification. (e) Sclerosing Pneumocytoma Mib-1×100 Magnification.