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Lung tumor

Benign tumors

Sclerosing hemangioma


Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 8 January 2013, last major update September 2012
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Papillary pattern or islands filled with bland polygonal cells with abundant eosinophilic cytoplasm and indistinct cell borders, with sclerotic stroma
● Also called pneumocytoma, sclerosing pneumocytoma, papillary pneumocytoma (Arch Pathol Lab Med 2009;133:820)
● 80% women, ages 30-50 years, present with incidental solitary nodule on chest Xray
● Apparently derived from type II pneumocytes or with differentiation towards these cells
● Almost always benign, although 2-4% have nodal metastases that don’t appear to affect prognosis (Arch Pathol Lab Med 2003;127:321)
● Sclerosis and hemorrhage are probably secondary changes

Case reports
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● 23 year old woman with dry cough and dyspnea (Arch Pathol Lab Med 2003;127:377)
● Metastatic spread to stomach (Histopathology 2012;60:1162)

Gross description
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● Well circumscribed, non-encapsulated, easily shelled out, tan-yellow, may be hemorrhagic, usually peripheral lung

Gross images
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Tan-yellow tumor

Micro description
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● Papillary, sclerotic, solid or hemorrhagic patterns of bland polygonal or surface cuboidalcells with abundant eosinophilic cytoplasm and indistinct cell borders
● May have sclerotic stroma, may be continuous with bronchial epithelium
● Frequent hemorrhage, aggregates of histiocytes
● No/rare granulomatous reaction, no/rare mitotic figures
● No angiolymphatic invasion, no necrosis

Micro images
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Various images


Young Asian woman with lung tumor (images contributed by anonymous)

Positive stains
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● EMA, keratin (focal), LeuM1, TTF1, PR, ER (weak), surfactant proteins, Napsin A (Histopathology 2012;60:361), p53 mutation higher in polygonal cells (J Clin Pathol 2008;61:192)
● Distinct expression of B-catenin, Axin, and C-myc in 2 cell types (Virchows Arch 2012;461:59, Histopathology 2012;61:178)

Negative stains
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● CEA, S100, smooth muscle actin, chromogranin, CD34

Differential diagnosis
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Alveolar or papillary adenoma
Carcinoid tumor
● Carcinoma (primary or metastatic)
Clear cell (“sugar”) tumor
Epithelioid hemangioendothelioma
Langerhans cell histiocytosis
● Meningioma
● Meningothelial-like nodules

End of Lung tumor > Benign tumors > Sclerosing hemangioma


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