Pulmonary sclerosing hemangioma with liver metastasis: report of one case and literature review

Abstract

Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of pulmonary sclerosing hemangioma (PSH) with liver metastasis. Methods Clinical data of one patient with PSH who was diagnosed and treated in Cancer Hospital Affiliated to Zhengzhou University in July 2012 were retrospectively analyzed. The informed consent of the patient was obtained and the local ethical committee approval was received. The female patient, aged 33 years old, was admitted to hospital due to a space-occupying mass in the right lung found by physical examination for 1 week. CT scan revealed a mass approximately 4.3 cm × 2.8 cm in size in the medial segment of the middle lobe of right lung. Enhanced CT scan revealed uneven enhancement within the mass. Low-differentiated adenocarcinoma was identified by CT-guided lung biopsy. The patient was clinically diagnosed with lung adenocarcinoma. Results The patient underwent thoracoscopic resection of middle lobe of right lung + mediastinal lymph node dissection under the general anesthesia with endotracheal intubation on July 9th, 2012. A tumor approximately 4.5 cm×4.0 cm×2.2 cm in size was found in the middle lobe of right lung during the operation. It was diagnosed as low-differentiated adenocarcinoma, part of which was characterized as PSH by postoperative pathological examination. In December 2015, a space-occupying lesion in the right lobe of liver was found by MRI re-examination. Liver biopsy indicated a PSH with liver metastasis. HE staining revealed the lesion presented a mixed type of hemorrhage, solid and cirrhosis regions. Immunohistochemical staing revealed positive outcomes for thyroid transcription factor (TTF-1) and epithelial membrane antigen (EMA). Then the patient underwent ultrasound-guided radiofrequency ablation and recovered well after surgery. The patient was followed up on a regular basis and remained physically stable until the submission date. Conclusions PSH with liver metastasis is an extremely rare disease. Clinical diagnosis relies on the results of pathological examination. Surgical resection is a reliable therapy with a relatively good prognosis. Key words: Liver neoplasms; Pulmonary sclerosing hemangioma; Lung adenocarcinoma; Radiofrequency ablation; Prognosis