Sclerosing hemangioma presented by huge mediastinal lymph nodes metastasis, mimicking lung malignancy

Abstract

Introduction: Sclerosing hemangioma (SH) is a rare pulmonary tumor mainly with benign features. Recently, we experienced a case of SH which involved multiple lymph nodes with unusually extreme size that initially seemed like advanced lung cancer. Case: Fifty aged female had a lung mass and a satellite nodule in left lower lobe. In addition, several lymph nodes of left hilar, para-aortic, sub-aortic and left interlobar zone were enlarged. Computed tomography (CT) showed a 3.9cm sized mass with a 1.2cm sized satellite nodule in left lower lobe and maximum diameter of enlarged node was 3.5 cm on CT scan. Standard uptake value presenting FDG-uptake in positron emission tomography (PET) was various with levels from 3.4 to 4.2 in lymph nodes and 4.0 in the main mass of left lower lobe. Undiagnosed pathologic report of percutaneous transthoracic lung biopsy was followed by video assisted thoracoscopic surgery with wedge resection. Mediastinal and hilar nodes were resected partially. SH was diagnosed with mixed pathologic features of hemorrhagic, papillary, solid and sclerotic pattern in both masses and lymph nodes. She has received regular follow-up checks without further treatment. Previously, 2 cm sized node enlargement was a maximum diameter in our knowledge (YMJ 44:150-4, 2003). This case of SH with lymph node metastasis is very rare and the extreme sized lymph node enlargement is an unusual presentation. Educational points: Sclerosing hemangioma can present unusually increased lymph node enlargement with multiple lung nodules and also have positive PET uptakes. Sometimes, SH can present a feature of low grade malignant potency.