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Case Reports
. 2018 Dec 15;57(24):3631-3635.
doi: 10.2169/internalmedicine.1063-18. Epub 2018 Aug 10.

CT-guided Biopsy for the Diagnosis of Pulmonary Epithelioid Hemangioendothelioma Mimicking Metastatic Lung Cancer

Akiko Sasaki  1 , Hideto Egashira  1 , Hideyasu Sugimoto  2 , Kenichi Seki  3 , Toshitaka Tsukiyama  4 , Chikamasa Ichita  1 , Shinnosuke Tokoro  1 , Satoshi Takizawa  4 , Izumi Kitagawa  3 , Shinichi Teshima  5 , Makoto Kako  1
Affiliations
Case Reports

CT-guided Biopsy for the Diagnosis of Pulmonary Epithelioid Hemangioendothelioma Mimicking Metastatic Lung Cancer

Akiko Sasaki et al. Intern Med. .

Abstract

A 69-year-old male patient presented with multiple lung nodules revealed by chest-computed tomography (CT) during a preoperative examination for an appendiceal tumor. The nodule diameters ranged from 2-10 mm without either pleural thickening or effusions. A fluorine-18-labeled fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET)/CT scan showed a high FDG uptake in the appendiceal tumor, but almost normal standardized uptake values in the bilateral lung nodules. A CT-guided biopsy led to a diagnosis of pulmonary epithelioid hemangioendothelioma, a rare vascular tumor with a radiological presentation similar to that of a metastatic lung tumor. The present case is the first to describe successful treatment using a CT-guided biopsy instead of more conventional methods.

Keywords: minimally invasive procedure; multiple lung nodules; thoracoscopic biopsy; vascular tumor.

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Figures

Figure.
Figure.
Imaging of the appendiceal tumor and PEH. (A) Colonoscopy revealed a 15-mm Paris class 0-IIa lesion located in the appendiceal orifice. (B) Computed tomography (CT) scan revealed multiple bilateral lung nodules. The nodule diameters ranged from 2 to 10 mm (yellow arrow head points to a 10-mm lesion). (C) 18F-FDG-PET/CT revealed an appendiceal tumor with a maximum SUV of 2.4 (yellow arrow head). (D) Bilateral lung nodules showed normal SUVs, and the largest nodule (10 mm) showed an SUV of 1.0 (yellow arrow head). (E) A specimen composed of pale eosinophilic nonstructural substances, which contained epithelioid spindle and cubic mid-sized tumor cells (100 HPF). (F) Immunohistopathologic staining showed the tumor cells to be endothelial in origin and immunoreactive for CD34 (100 HPF).
See this image and copyright information in PMC

References

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