Pitfalls and Key Features of a Case of Sclerosing Pneumocytoma: A Cytological Challenge?

Abstract

Background: The aim of the current case report is to re-evaluate the key features and pitfalls of fine-needle aspiration cytology (FNAC) in the diagnosis of sclerosing pneumocytoma (previously named sclerosing hemangioma) and to establish the importance of FNAC in addressing a proper surgical strategy. Case: Herein we documented a case of a 70- year-old man with a lung nodule which showed a hypermetabolic uptake on positron emission tomography. He therefore underwent FNAC under computed tomography scan guidance with a 22-gauge needle. The cytopathological examination allowed a diagnosis of sclerosing pneumocytoma. A wedge surgical excision was performed and the histological examination confirmed the cytological diagnosis. Conclusion: FNAC is a fundamental tool for distinguishing sclerosing pneumocytoma from a malignant lung tumour and together with clinical, radiological and pathological multidisciplinary assessment is indispensable in planning appropriate surgical management. Cytopathologists should be aware of the pitfalls and key features of the cytopathological diagnosis of sclerosing pneumocytoma, which can significantly change the surgical approach to the patient and protect him from aggressive overtreatment.

Pulmonary sclerosing pneumocytoma: Cytomorphology and immunoprofile

“…Cuboidal cells were noted in 2 cases in the current series, a feature that has been reported in several published SP cases . Bland round cells and spindle cells also may be arranged in sheets to form a pavement‐like pattern . Round, bland‐appearing single cells along with papillary fragments and hemosiderin‐laden macrophages together raise the possibility of SP on direct smears.…”

Imprint cytologic and immunocytochemical findings of sclerosing pneumocytoma

“…In imaging analyses, SP may resemble lung cancer, metastatic cancer, pulmonary hamartoma or even tuberculosis . SP usually shows the hypometabolic lesion on the fluorodeoxyglucose positron emission tomography/computed tomography (PET‐CT), but some cases with SP may show the uptake in PET‐CT . SP usually occurs as a solitary mass, but some cases may arise multiply .…”

“…Accordingly, cytologists and pathologists can recognize surface and stromal round cells in imprint cytological materials. [1][2][3][4][5][6][7][8][9] Intranuclear inclusion may be a clue identifying surface cells. 6 By accurate grasping the cell characteristics of both cells, we can identify both cells even in fine needle aspiration materials.…”

“…6 By accurate grasping the cell characteristics of both cells, we can identify both cells even in fine needle aspiration materials. [1][2][3][4][5][7][8][9] To the best of our knowledge, there are only two cases that imprint cytological findings of SP have been described. 6 In the present study, we reported the first case of immunocytochemical study on SP using a cell transfer method.…”

“…[1][2][3][4][5][6][7][8][9] Among them, authors have chiefly focused on fine needle aspiration findings. [1][2][3][4][5][7][8][9] To the best of our knowledge, there are only two cases of imprint cytology of SP to date. 6 In this article, we report imprint cytological findings of three additional cases with SP.…”