A case of pulmonary sclerosing pneumocytoma diagnosed preoperatively using transbronchial cryobiopsy

Yutaka Muto; Naoyuki Kuse; Minoru Inomata; Nobuyasu Awano; Mari Tone; Jonsu Minami; Kohei Takada; Kazushi Fujimoto; Ami Wada; Keita Nakao; Yoshiaki Furuhata; Chisa Hori; Yuan Bae; Toshio Kumasaka; Takehiro Izumo

doi:10.1016/j.rmcr.2021.101494

A case of pulmonary sclerosing pneumocytoma diagnosed preoperatively using transbronchial cryobiopsy

Respir Med Case Rep. 2021 Aug 11:34:101494. doi: 10.1016/j.rmcr.2021.101494. eCollection 2021.

Authors

Affiliations

¹ Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan.
² Department of Thoracic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan.
³ Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan.

Abstract

Background: The preoperative diagnosis of pulmonary sclerosing pneumocytoma (PSP) is complicated since PSP has several histological structural patterns in the same neoplasm; hence, it is sometimes pathologically misdiagnosed as adenocarcinoma or carcinoid. In recent years, with the prevalence of transbronchial cryobiopsy (TBLC), we are able to obtain larger specimens than previously. However, to date, there have been no reports describing PSP diagnosed using TBLC.

Case reports: A 43-year-old man was referred to our hospital for an abnormal lesion in the left lung discovered on routine health examination. A computed tomography scan of the chest revealed a 14-mm heterogeneous round nodule with surrounding ground-glass opacity in the left lower lobe. The tumor size increased to 18 mm in three weeks, and he developed bloody sputum. TBLC was performed using radial endobronchial ultrasonography and fluoroscopy. An occlusion balloon and prophylactic epinephrine were used to prevent severe bleeding. Histologically, epithelioid cells with solid proliferation, various papillary lesions, and hemosiderin-laden histiocytes were observed. Immunohistochemical staining revealed the histiocytes positive for thyroid transcription factor-1 and vimentin, and the type II pneumocyte-like-cells positive for cytokeratin 7. The tumor was preoperatively diagnosed as a PSP; the patient underwent left basal segmentectomy and consequently, a final diagnosed of PSP was formulated.

Conclusion: We report the first case of PSP preoperatively diagnosed using TBLC. Therefore, cryobiopsy could be beneficial in the preoperative diagnosis of PSP.

Keywords: Cryobiopsy; Pulmonary sclerosing pneumocytoma.

Publication types

Case Reports