Coexistence of Multiple Pulmonary Sclerosing Pneumocytoma and Scleroderma-Rheumatoid Arthritis Overlap Syndrome: A Case Report

Abstract

Pulmonary sclerosing pneumocytoma is a rare, low-grade pulmonary tumor observed as unilateral or bilateral multiple nodules at a rate of 4%-5%. Among the autoimmune connective tissue disorders, those most commonly associated with lung malignancies are sclero- derma and rheumatoid arthritis. In this study, we report a rare case of a 55-year-old middle-aged Asian woman with slow-growing bilat- eral multiple pulmonary sclerosing pneumocytoma and scleroderma-rheumatoid arthritis overlap syndrome. The autoimmune disorders and pulmonary fibrosis of this case might have led to the development of PSP.

Figures 1.

(A) Right lung apical juxtapleural 1.3 cm nodule (blue arrow); (B) Left lung hilar 1.5 cm nodule with overlying vessel sign (blue arrow); (C) Right lung lower lobe 2.5 cm nodule and right lung middle lobe, paracardiac, irregularly circumscribed 3 cm diameter consolidation and bilateral lung lower lobe consolidations on contrast-enhanced Thoracic CT (August 25, 2021); (D) Right apical, juxtapleural 1.3 cm nodule (blue arrow) (SUVmax:3.6); (E) Left hilar 1.5 cm nodule (blue arrow) (SUVmax:3.4); (F) Right lower lobe 2.5 cm nodule (SUVmax:4.9) (blue arrow) and right middle lobe, paracardiac, irregularly circumscribed 3 cm diameter consolidation and bilateral lower lobe consolidations (SUVmax:3.6) on PET-CT. PET, positron emission tomography; CT, computed tomography

Figures 1.

(A) Right lung apical juxtapleural 1.3 cm nodule (blue arrow); (B) Left lung hilar 1.5 cm nodule with overlying vessel sign (blue arrow); (C) Right lung lower lobe 2.5 cm nodule and right lung middle lobe, paracardiac, irregularly circumscribed 3 cm diameter consolidation and bilateral lung lower lobe consolidations on contrast-enhanced Thoracic CT (August 25, 2021); (D) Right apical, juxtapleural 1.3 cm nodule (blue arrow) (SUVmax:3.6); (E) Left hilar 1.5 cm nodule (blue arrow) (SUVmax:3.4); (F) Right lower lobe 2.5 cm nodule (SUVmax:4.9) (blue arrow) and right middle lobe, paracardiac, irregularly circumscribed 3 cm diameter consolidation and bilateral lower lobe consolidations (SUVmax:3.6) on PET-CT. PET, positron emission tomography; CT, computed tomography

Figures 2.

(A) Neoplastic epithelial cells lining around the fibrovascular core (H&E 10×10); (B) Neoplastic epithelial cells with columnar, eccentric core, eosinophilic cytoplasm around the fibrovascular core (H & E 40×10), C. Strong diffuse immune reaction in neoplastic epithelial cells with TTF-1 (20×10). H & E, hematoxylin and eosin; TTF-1, thyroid transcription factor-1.