Pulmonary sclerosing hemangioma mimicking bronchial malignancy: A case report

Pulmonary sclerosing hemangioma is a rare benign neoplasm of the lung and predominantly occurs in female patients. Commonly, it presents as asymptomatic solitary pulmonary nodule on chest radiograph. We report a case of pulmonary sclerosing hemangioma who presented with fever and chest x-ray and computed tomography revealed cavitary lesion and mediastinal lymphadenopathy . The chest imaging findings were mimicking bronchial carcinoma. On histopathology and immune-cyto-histochemistry, we found her as having pulomonary sclerosisng hemangioma.The patient is now on follow up without any progression of the disease for last two months. Birdem Med J 2019; 9(3): 251-253

Symptomatic pulmonary sclerosing hemangioma: a rare case of a solitary pulmonary nodule in a woman of advanced age

Background Pulmonary sclerosing hemangioma (PSH) is a rare tumor that usually develops in middle-aged Asian women. PSH has four histological types (hemorrhagic, sclerotic, solid, and papillary) and often grows slowly in a lower lobe of the lung. Preoperative misdiagnosis frequently occurs because of the absence of specific clinical manifestations and imaging findings. Few reports have described PSH in women of advanced age. Case presentation: A 75-year-old woman presented to our hospital in China with a 5-day history of productive cough and intermittent hemoptysis. Computed tomography indicated bronchiectasis and a large mass in the left inferior lobe of the lung. Treatment of the bronchiectasis provided no symptom relief. The hemoptysis resolved following left lower pulmonary lobectomy, and PSH was pathologically diagnosed following surgery. At the time of this writing (after 6 months of follow-up), the tumor had not recurred, no metastases had been detected, and close follow-up was ongoing. Conclusions Both bronchiectasis and PSH can cause hemoptysis. This case demonstrates that PSH should be included as a differential diagnosis of hemoptysis in women of advanced age. For patients with chronic hemoptysis, the diagnosis of PSH should be considered if the therapeutic effect of bronchiectasis is poor.

Whole-exome sequencing identifies recurrent AKT1 mutations in sclerosing hemangioma of lung

Pulmonary sclerosing hemangioma (PSH) is a benign tumor with two cell populations (epithelial and stromal cells), for which genomic profiles remain unknown. We conducted exome sequencing of 44 PSHs and identified recurrent somatic mutations of AKT1 (43.2%) and β-catenin (4.5%). We used a second subset of 24 PSHs to confirm the high frequency of AKT1 mutations (overall 31/68, 45.6%; p.E17K, 33.8%) and recurrent β-catenin mutations (overall 3 of 68, 4.4%). Of the PSHs without AKT1 mutations, two exhibited AKT1 copy gain. AKT1 mutations existed in both epithelial and stromal cells. In two separate PSHs from one patient, we observed two different AKT1 mutations, indicating they were not disseminated but independent arising tumors. Because the AKT1 mutations were not found to co-occur with β-catenin mutations (or any other known driver alterations) in any of the PSHs studied, we speculate that this may be the single-most common driver alteration to develop PSHs. Our study revealed genomic differences between PSHs and lung adenocarcinomas, including a high rate of AKT1 mutation in PSHs. These genomic features of PSH identified in the present study provide clues to understanding the biology of PSH and for differential genomic diagnosis of lung tumors.

Sclerosing Hemangioma of the Lung and Concurrent Sarcoidosis of the Hilar Lymph Nodes

Objective: To present chest radiographs, CT and pathological fndings of pulmonary sclerosing hemangioma with concurrent sarcoidosis. To review the literatures regarding lung cancer and associated sarcoidosis and/or sclerosing hemangioma.Materials and Methods: A 50 year-old female patient was screened for health at human dock at Preventive Medicine Research Center of our institution, and a rounded nodule, measuring about 15 mm in diameter, was found in the left lower lung feld medially. Non-enhanced CT showed a round nodule at the left cardiac border. The patient was sent to a clinic of our institution.Results: The patient was further studied by contrast enhanced CT (CECT), which showed marked increase of CT value to 91.8 HU from 50.1 HU on non-enhanced CT. It was difcult to di?erentiate a benign lesion from malignant lesion. CECT also showed enlarged hilar and mediastinal lymph nodes. Cytology at the time of bronchoscopy revealed Class 3 at the left B5b bronchus. Partial resection of the lingual was carried out by video-assisted thoracoscopic surgery. Biopsy of the left hilar nodes (#10, #11) at the same time revealed sarcoidosis.Conclusion: A rare case of pulmonary screlosing hemangioma and concurrent sarcoidosis was reported with imaging results and pathological proof.