Pulmonary sclerosing pneumocytoma with mediastinal lymph node metastasis

Soo, Ing Xiang; Sittampalam, Kesavan; Lim, Chong Hee

doi:10.1177/0218492317727668

Cited by 15 publications

(18 citation statements)

References 7 publications

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“…We reviewed the literature, and identified 25 PSH cases with lymph node or distant metastasis, including three of the cases reported herein (Table 2). 2,5,[7][8][9][10][13][14][15][16][17][18][19][20][21][22][23][24][25] Although the data for one patient were incomplete, the clinicopathological data of the other 24 patients are shown in Table 2. Twenty-two PSP cases with positive lymph nodes have been reported so far.…”

Section: Discussionmentioning

confidence: 99%

Clinical and histopathological features of pulmonary sclerosing pneumocytoma with dense spindle stromal cells and lymph node metastasis

et al. 2020

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Aims: To determine the clinicopathological features of pulmonary sclerosing pneumocytoma (PSP) with spindle cells and in cases with positive detection of PSP cells in the lymph nodes. Methods and results: This article report the clinical, histological and immunohistochemical features of PSP with dense spindle stromal cells in five patients (including one case with lymph node metastasis) and PSP accompanied by positive nodes in two patients out of 239 cases diagnosed at our institution between 2007 and 2019. The literature on PSP was also reviewed in detail. Six patients were female, and one (with a positive node) was male; their average age was 53 years. Thoracic imaging revealed solid tumours with clear borders and a uniform texture in six patients, but one patient had a lobulated tumour with uneven densities. All tumours were unifocal, and they had an average size of 31 mm. Tumours from five cases were mainly composed of solid regions of diffuse spindle cells rather than polygonal cells. Immunohistochemical staining demonstrated that thyroid transcription factor-1, vimentin, epithelial membrane antigen (weak) and oestrogen receptor (partial) were expressed in spindle cells. The average follow-up time was 31 months. Two of the 234 PSP cases for which adequate data were available had positive nodes (metastasis rate: 0.8%), and one of the five patients with PSP with spindle cells showed lymph node metastasis (metastasis rate: 20%). In addition, stromal cells were found to be predominant at metastatic sites. Conclusions: Spindle cells are present among the stromal cells of PSP, and not all of them are round cells. PSP patients with spindle cells or male patients may be more prone to metastasis than others.

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Section: Discussionmentioning

confidence: 99%

Clinical and histopathological features of pulmonary sclerosing pneumocytoma with dense spindle stromal cells and lymph node metastasis

et al. 2020

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“…The malignant progression and metastasis of PSP were extremely rare. The reported PSP patients with LN [9,13,14,23] or organ metastases [11,24] were mostly females, and only one male patient suffered from mediastinal LN metastasis [25]. Herein, we reported an extremely atypical case: a young male patient suffering from an aggressive PSP with multiple LN and organ metastases during 7 months after the resection of the primary lung lesion.…”

Section: Discussionmentioning

confidence: 88%

“…Occasionally, PSP may manifest as multiple lesions, recurrence, regional lymph node (LN), or single organ metastasis, but does not seem to affect the prognosis. Therefore, PSP is considered as a benign or a low-grade malignant potential primary lung tumor [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological and Molecular Characteristics of Atypical Pulmonary Sclerosing Pneumocytoma With Multiple Metastases

Wang¹,

Yang²,

Jiang³

et al. 2020

Preprint

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Background: Few patients with pulmonary sclerosing pneumocytoma (PSP) may suffer from recurrence and oligometastasis as it is a benign tumor or has a low malignancy potential. Herein, an in-depth study, based on an extremely rare PSP case with atypical features, was carried out to elaborate the potential mechanism underlying the rapid malignant progression. Methods: The clinicopathological data of this atypical PSP (AP) case were obtained. Formalin‑fixed and paraffin‑embedded tissues from all the lesions of AP and five classic PSP cases (as control) were used for whole-exome sequencing (WES) and immunohistochemistry. Results: A 23-year-old male showed a 6.5-cm pulmonary nodule in the right middle lobe (RML) and enlarged mediastinal lymph nodes (LNs). He underwent thoracoscopic RML lobectomy, systematic LNs dissection, and mediastinal lymphadenectomy. The metastases to the cervical LNs and liver were detected in a short period and then resected. Postoperative pathological examination confirmed the diagnosis of PSP in all the lesions, based on the typical histological characteristics and immunophenotypes. Furthermore, WES identified both AKT1 E17K somatic mutation and TP53 C176Y germline mutation in this AP case. The genomic evolution analysis showed different evolutionary branches in the metastatic tumors distinct from the primary lesion. Moreover, compared to the control group, the AP case showed high copy number variations (CNVs) and significantly high copy number instability (CNI). Conclusions: We speculated that the atypical histopathological features and malignant behaviors may be due to the co-mutations of somatic AKT1 E17K and germline TP53 C176Y, combined with the high CNVs and CNI.

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“…Previous studies show that MET process is able to promote distal metastasis in breast cancer [29], especially for establishing macrometastasis [30–32], which, combined with our results, suggests that the the MET process may play an important role in lymph node metastasis of PSP. Although based on previous studies, lymph node involvement doesn’t affect long-term survival rate [6, 23], patients with malignant PSP may still need close follow-up.…”

Section: Discussionmentioning

confidence: 99%

First report of pulmonary sclerosing pneomucytoma with malignant transformation in both cuboidal surface cells and stromal round cells: a case report

Teng

2019

BMC Cancer

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BackgroundPulmonary sclerosing pneumocytoma (PSP) is a rare benign tumor. Although lymph node metastasis has been reported, it is still considered benign. No malignant transformation has been reported. This is the first case of malignant transformation of both cuboidal surface cells and stromal round cells.Case presentationA 64-year-old male had been complaining of intermittent hemoptysis several times per day for eight months. Chest computed tomography scan showed parenchymal infiltration with cystic lesion in the right lower lobe accompanied by enlarged right hilar lymph nodes. Lobectomy and systemic lymph node dissection was performed.On grossly pathological examination, the lesion was 50 mm from the bronchial stump. It was a mixture of both cystic and solid components and 30 mm * 20 mm in size with unclear border. Microscopically, the cuboidal surface cells transformed to adenocarcinoma. The stromal round cells also had a malignant transformation. The Ki-67 proliferation index in malignant cuboidal surface cells and stromal round cells were 70 and 55%, respectively. Furthermore, E-cadherin was negative in primary tumor but positive in metastatic lymph node, which suggested that the mesenchymal to epithelial transition may play an important role in lymph node metastasis.ConclusionsTo our knowledge, we present the first case of malignant transformation of both cuboidal surface cells and stromal round cells in PSP. The process of mesenchymal to epithelial transition may play an important role in lymph node metastasis.

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Pulmonary sclerosing pneumocytoma with mediastinal lymph node metastasis

Cited by 15 publications

References 7 publications

Clinical and histopathological features of pulmonary sclerosing pneumocytoma with dense spindle stromal cells and lymph node metastasis

Clinical and histopathological features of pulmonary sclerosing pneumocytoma with dense spindle stromal cells and lymph node metastasis

Clinicopathological and Molecular Characteristics of Atypical Pulmonary Sclerosing Pneumocytoma With Multiple Metastases

First report of pulmonary sclerosing pneomucytoma with malignant transformation in both cuboidal surface cells and stromal round cells: a case report

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