Multiple pulmonary sclerosing hemangioma appearing as primary adenocarcinoma on intraoperative frozen section examination

Abstract

Background. Pulmonary sclerosing hemangioma is a benign and rare entity which sometimes presents as multiple nodules. Case. A thyroid tumor and bilateral multiple pulmonary nodules were incidentally found in a 52-year-old woman when she underwent extirpation of a benign cervical spinal tumor. Fine needle aspiration of the thyroid tumor failed to identify malignant cells but could not completely rule out a possible malignancy with metastatic pulmonary nodules, which led her to eventually undergo video-assisted partial lung resection. The resected specimens from the right lung were diagnosed as primary adenocarcinoma on intraoperative examination of the frozen sections, which led us to terminate the surgery without resection of the contralateral lesions. However, postoperative examination of the same specimens demonstrated histological findings compatible with those of sclerosing hemangioma. Conclusion. Multiple pulmonary nodules, even though they demonstrate features suggestive of benign nodules on imaging, are difficult to distinguish from metastatic tumors if an identifiable indeterminate mass lesion co-exists in an extrapulmonary site susceptible to a common malignancy. In addition, pulmonary sclerosing hemangioma is difficult to distinguish from papillary adenocarcinoma on examination of the frozen section in some cases, which may create intraoperative dilemmas for surgeons in cases of multiple lesions.