2022 Volume 36 Issue 4 Pages 472-477
In 2015, the name "sclerosing hemangioma" was changed to "sclerosing pneumocytoma" in the World Health Organization classification of lung tumors. Sclerosing pneumocytoma is a rare tumor that accounts for approximately 1 to 5% of lung tumors. It is frequently noted in middle-aged women, and lymph node metastasis and multiple nodules occur in nearly 1 and 4% of cases, respectively. We report a case of surgical resection for sclerosing pneumocytoma with multiple nodules and lymph node metastasis.
A 25-year-old woman presented with an abnormal chest shadow on a chest radiograph. Chest computed tomography revealed multiple nodular shadows distributed in the lower left lobe (S10). Sclerosing pneumocytoma was diagnosed through transbronchial lung biopsy, surgical resection was selected, and thoracoscopic left S10 segmentectomy was performed. The operation lasted for 5 hours 26 minutes, and the patient lost 20 mL of blood preoperatively. The patient recovered without complications and was discharged from the hospital on postoperative day 2. Pathological diagnosis also revealed sclerosing pneumocytoma, and metastasis was observed in LN#13.
Owing to its pathological diversity, sclerosing pneumocytoma is difficult to diagnose before surgery or even with frozen sectioning during surgery. In the current case, a definitive diagnosis was obtained preoperatively, and we selected surgical resection. Reportedly, lymph node metastasis typically occurs when the lesion is larger than 3 cm, but in the current case, the lesion size was approximately 12 mm, and tumor sizes associated with lymph node metastasis were not observed on CT. Therefore, lymph node dissection was not performed. However, even with small lesions, lymph node dissection should be considered if there are multiple nodules. There were multiple nodules in the current case, and it was a very rare case as lymph node metastasis was also recognized. An extensive literature search failed to reveal similar reports. Although uncommon, there have been reports of recurrence but no reports of relapse-related deaths in patients with sclerosing pneumocytoma. Nevertheless, careful long-term follow-up remains necessary.
