Solitary pulmonary capillary hemangioma: Clinicopathologic and radiologic characteristics of nine surgically resected cases

A 75-Year-Old Man With Irregular Solid Components Within an Emphysematous Bulla

CASE PRESENTATION

A 75-year-old man presented to our hospital with cough and sputum for more than a year. Eight months previously, the patient was admitted to a local hospital, and his symptoms were relieved after symptomatic treatment (expectorants and antitussives). Three months ago, he was admitted to our hospital, and his symptoms improved with antiinflammatory therapy. He had a 30-pack-years history of smoking (20 cigarettes/day) and a history of drinking (200 g liquor per day). The patient had no history of genetic disorders or cancer. He did not present with fever, dyspnea, hemoptysis or chest distress, and there was no history of weight loss since onset.

A case of resected pulmonary capillary hemangioma with a literature review

Pulmonary hemangiomas are benign, relatively rare tumours. Because computed tomography (CT) findings show a variety of images, it is often difficult to distinguish hemangiomas from lung cancer and other benign tumours. We report a 63-year-old man who was diagnosed with a pulmonary capillary hemangioma (PCH). A right lung basal segmentectomy was performed for diagnosis and treatment. On chest CT, the lesion was shown to be a solid nodule with contrast-enhanced margins. This finding was thought to reflect the dense vascular hyperplasia of the central part of the tumour based on the pathologic findings. Although few studies involving PCH have referred to contrast-enhanced CT, the findings of contrast-enhanced CT might be a valuable indicator for diagnosing PCH.

Solitary Pulmonary Capillary Hemangioma: CT and PET-CT Features with Clinicopathologic Correlation

The aim of this study was to evaluate the CT and PET-CT features of solitary pulmonary capillary hemangioma (SPCH) with clinicopathologic correlations. This retrospective study included 17 patients with histologically proven SPCH from four tertiary institutions. The clinical, pathological and imaging findings of SPCH were reviewed. The CT features assessed included lesion location, size, density, contour, margin, enhancement, presence of air bronchogram, perivascular lucency and pleural retraction, and 18F-fluorodeoxyglucose uptake on PET-CT. Changes in the size during the follow-up period were also evaluated. Imaging features were correlated with the clinicopathologic findings. The mean age of the patients was 47 years (range 30–60 years). All SPCHs were incidentally detected during screening CT examinations (n = 13, 76%) or during cancer work-up (n = 4, 24%). Most SPCHs appeared as part-solid nodules (n = 15, 88%), the remaining appeared as a pure ground-glass nodule or a pure solid nodule, respectively. Most had smooth contours (n = 16, 94%), while one had a lobulated contour. Nine SPCHs (53%) showed ill-defined margins. Air bronchogram was present in ten (59%) SPCHs, and perivascular lucency in two (12%). All SPCHs exhibited hypoattenuation on contrast-enhanced CT and hypometabolism on PET-CT. During the follow-up period (mean 14.8 ± 17.7 months), the lesions showed no change in size or density in ten SPCHs (59%), decreased or fluctuation in size and density in three (18%). SPCH is often incidentally detected in young and middle-aged adults, commonly as an ill-defined part-solid nodule that may accompany air bronchogram, perivascular lucency, and fluctuation in size or density on CT and hypometabolism on PET-CT.

A radiomics model can distinguish solitary pulmonary capillary haemangioma from lung adenocarcinoma

OBJECTIVES

Solitary pulmonary capillary haemangioma (SPCH) is a benign lung tumour that presents as ground-glass nodules on computed tomography (CT) images and mimics lepidic-predominant adenocarcinoma. This study aimed to establish a discriminant model using a radiomic feature analysis to distinguish SPCH from lepidic-predominant adenocarcinoma.

METHODS

In the adenocarcinoma group, all tumours were of the lepidic-predominant subtype with high purity (>70%). A classification model was proposed based on a two-level decision tree and 26 radiomic features extracted from each segmented lesion. For comparison, a baseline model was built with the same 26 features using a support vector machine as the classifier. Both models were assessed by the leave-one-out cross-validation method.

RESULTS

This study included 13 and 49 patients who underwent complete resection for SPCH and adenocarcinoma, respectively. Two sets of features were identified for discrimination between the 2 different histology types. The first set included 2 principal components corresponding to the 2 largest eigenvalues for the root node of the two-level decision tree. The second set comprised 4 selected radiomic features. The area under the receiver operating characteristic curve, accuracy, sensitivity, specificity were 0.954, 91.9%, 92.3% and 91.8% in the proposed classification model, and were 0.805, 85.5%, 61.5% and 91.8% in the baseline model, respectively. The proposed classification model significantly outperformed the baseline model (P < 0.05).

CONCLUSIONS

The proposed model could differentiate the 2 different histology types on CT images, and this may help surgeons to preoperatively discriminate SPCH from adenocarcinoma.

Solitary pulmonary capillary hemangioma presenting with a ground glass opacity: A case report & literature review

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Solitary pulmonary capillary hemangioma (SPCH) is a rare benign lung tumor.

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SPCH presents with a ground glass opacity on CT scan.

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Preoperative definitive diagnosis as SPCH is a real challenge.

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Immunohistochemical staining is essential for diagnosis as SPCH.

Introduction

Solitary pulmonary capillary hemangioma (SPCH) is a rare benign lung tumor that clinically resembles early lung cancer and precancerous pulmonary lesions that present with similar imaging manifestations.

Presentation of case

The patient was a 54-year-old Japanese man who was referred to Nagara Medical Center with a ground glass opacity (GGO) lesion within the right upper lung that was incidentally detected on computed tomography. After 8 months of follow-up, video-assisted thoracoscopic segmental resection of the right upper lobe was performed with diagnostic and therapeutic intent. Pathologic examination of the resected specimen demonstrated thickening of the alveolar septum caused by the proliferation of capillary vessels. This lesion was positive for CD31 and CD34 and negative for thyroid transcription factor-1 and cytokeratin on immunohistochemical staining. The tumor was diagnosed as SPCH pathologically.

Discussion

When radiological examination demonstrates a GGO in the lung, SPCH must be considered as one of the differential diagnoses. For a definitive diagnosis, pathological examination of a surgically resected specimen must be conducted.

Conclusion

This study describes a case of SPCH and a review of the literature.

Progressively increasing density of the solid center of a ground-glass nodule in a solitary pulmonary capillary hemangioma: A case report

Solitary pulmonary capillary hemangiomas (SPCHs) are recently recognized, rare benign lesions that form solitary nodules owing to capillary proliferation. These lesions are usually detected incidentally as small ground-glass nodules (GGNs) on computed tomography (CT), and progressively enlarge over time. The radiological distinction from peripheral lung cancers is particularly challenging. However, to date, there have been no reports on progressive changes in the central density of SPCH on CT. An asymptomatic 49-year-old man was referred to our hospital for an abnormal shadow that was detected on chest CT during medical check-up. He was subsequently followed-up with chest CT. The nodule increased in size, and the central area became progressively denser. He underwent surgery 5 years and 10 months after the first visit owing to suspicion of lung cancer. Despite the collapse of the surgical specimen by artifacts, histopathological examination revealed a diagnosis of SPCH; collagenous fibers were found in the walls of the intralesional capillaries. The patient is presently alive without any recurrence, 6 months after the operation. In this case, the SPCH demonstrated a GGN with progressively increasing density of the central solid area on the CT. This remarkable feature made the preoperative distinction from lung cancer particularly difficult.

Surgical resection of a large hypopharyngeal hemangioma in an adult using neodymium-doped yttrium aluminum garnet laser: A case report

BACKGROUND

Generally, hemangiomas do not require surgical intervention; however, cases of large hemangiomas, potentially involving the throat and trachea, necessitate surgical therapy. Here, we present a case of hypopharyngeal hemangioma in an adult that was successfully treated with neodymium-doped yttrium aluminum garnet (Nd-YAG) laser.

CASE SUMMARY

Laryngoscopic examination of a 61-year-old man demonstrated the presence of a large, submucosal vascular lesion that extended into the epiglottis, left arytenoid cartilage, lateral to the aryepiglottic fold, and pyriform sinus. The lesion was resected and photocoagulated with limited hemorrhage using Nd: YAG laser. The hypopharyngeal hemangioma was completely excised. The patient showed no recurrence of hypopharyngeal hemangioma during the 1.5-year follow-up period.

CONCLUSION

Laser therapy is one of the effective tools for treating hemangiomas with rapid, uncontrolled growth or in functional areas, with few side effects and complications. The present case of a male patient with a large hypopharyngeal hemangioma, treated with YAG laser, demonstrates the efficacy of laser photocoagulation in treating cases of hemangiomas, without the risk of bleeding or airway obstruction. The favorable postoperative outcomes demonstrated by our patient with Nd: YAG laser therapy indicate its consideration in the therapy of similar cases.