Intraoperative Frozen Section Diagnosis Research Articles

Usefulness and faults of the sentinel lymph node biopsy using dye technique in distal gastrectomy for gastric cancer

e15509 Background: We apply sentinel node biopsy (SNB) in distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. We assessed usefulness and faults of intraoperative diagnosis of lymph node metastasis in this regard. Methods: Surgical procedures: Patent blue (1%) is injected submucosally into 4 to 5 different sites at 1 mL per site around the primary tumor. If blue nodes are found, biopsy and diagnosis of metastasis are performed at this point. Subjects and methods: The study was conducted in 96 gastric cancer patients with a preoperative diagnosis of T1 or mp invasion. Informed consent was obtained from the all patients. There were 65 males and 31 females with a mean age of 64.2 years. Tumor invasion of m, sm, mp, ss, and se was identified in 44, 38, 8, 2, and 4 patients, respectively. All patients underwent open distal gastrectomy (DG) (n=31) or laparoscopy-assisted distal gastrectomy (LADG) (n=65) and Billroth-I reconstruction. Results: The mean number of BNs dissected was 4.5 and 3.7 in DG and LADG cases, respectively. Intraoperative identification and biopsy of BNs could be performed in 34 of 35 DG patients and in 58 of 61 LADG patients. Of the 34 patients in whom BNs were identified, 5 had metastases in BNs confirmed by intraoperative frozen section diagnosis in DG cases. On the other hand, of the 58 LADG patients in whom BNs were identified, 5 had metastases in BNs confirmed by intraoperative frozen section diagnosis in LADG case. False-negative rate was 1.9%. Conclusions: SNB can be performed in LADG as well as in DG. For the case that shows infiltration up to MP, the possibility of lymph node metastasis for other lymph node is considered to be negligible. In obese cases we had some cases of no BNs and false-negative. In consequence, as long as the infiltration is lower than MP, and confirmed that metastasis was not found by blue node biopsy, distal gastrectomy using limited surgery would be thought to be done safely. No significant financial relationships to disclose.

Intraductal carcinoma component as a favorable prognostic factor in biliary tract carcinoma

The aim of this study is to evaluate the prognostic impact of an intraductal carcinoma component and bile duct resection margin status in patients with biliary tract carcinoma. An intraductal carcinoma component was defined as carcinoma within the bile duct outside the main tumor nodule consisting of a subepithelial invasive component. Surgically resected materials from 214 patients were evaluated by histological observations. Seventy-nine patients (36.9%) with an intraductal carcinoma component infrequently developed large tumors and infrequently showed deep invasion and venous, lymphatic and perineural involvement in the main tumor nodule. An intraductal carcinoma component was inversely correlated with advanced clinical stage, and was shown to be a significantly favorable prognostic factor by both univariate and multivariate analyses. Proximal (hepatic) side bile duct resection margin status was categorized into negative for tumor cells, positive with only an intraductal carcinoma component [R1 (is)], and positive with a subepithelial invasive component (R1). Forty-five patients (21.0%) with an R1 resection margin had a poorer prognosis than 148 patients (69.2%) with a negative resection margin, whereas 21 patients (9.8%) with an R1 (is) resection margin did not. In patients with an R1 resection margin, the risk of anastomotic recurrence was higher, and the period until anastomotic recurrence was shorter, than in patients with an R1 (is) resection margin. Surgeons should not be persistent in trying to achieve a negative surgical margin when the intraoperative frozen section diagnosis is R1 (is), and can choose a safe surgical procedure to avoid postoperative complications.

Age, Tumor Size, and In-Office Ultrasonography are Predictive Parameters of Malignancy in Follicular Neoplasms of the Thyroid

ObjectiveTo identify clinical predictors of malignancy in patients with intraoperative frozen-section diagnosis of follicular neoplasm of the thyroid. MethodsWe performed a retrospective cross-sectional study of 71 patients with intraoperative frozen-section diagnosis of follicular neoplasm who underwent thyroidectomy between January 1992 and December 2000. Age, sex, tumor size, and in-office ultrasonography characteristics of the lesions were assessed. These clinical factors were compared between cases that had benign definitive pathologic findings and those that were found to be carcinomas on permanent sections. ResultsNine (13%) of the 71 follicular neoplasms were found to be carcinomas after definitive pathologic evaluation. The incidence of malignancy was 13% (2/16) in men and 13% (7/55) in women (P>.5). Patients younger than 45 years had a 27% (8/30) incidence of malignancy compared with 2% (1/41) in patients 45 years or older (P<.01). Of tumors smaller than 4 cm, 7% (4/55) were ultimately diagnosed as carcinomas compared with 31% (5/16) of those 4 cm or larger (P = .05). When the in-office ultrasonography findings were interpreted as benign, only 7% (3/46) of cases were malignant compared with 40% (4/10) when the ultrasonography findings were suspicious (P = .02). ConclusionsAge and tumor size are predictive parameters of malignancy in follicular neoplasm of the thyroid. Suspicious ultrasonography findings also have an important predictive role. Total thyroidectomy is reasonable in patients with follicular neoplasm on frozen section if they are young (<45 years old), with large (>4 cm) tumors or if there are suspicious findings on in-office ultrasonography. (Endocr Pract. 2008;14:447-451)

Valeur de l’examen extemporané en pathologie thyroïdienne: Étude rétrospective de 1534 examens consécutifs

To assess the value of intraoperative frozen-section diagnosis in thyroid surgery and determine its limitations.This retrospective study examined the results of 1534 frozen sections of thyroid specimens analyzed over the 11-year period from 1995 through 2005 and their correlations with the final histological examination. Deferred responses were not taken into account for statistical calculations.In our series, frozen-section diagnosis was concordant with subsequent histopathological examination in 92% of cases, discordant in 3%, and deferred in 5%. The global specificity of frozen section analysis for all histological subtypes was 99.8% and its sensitivity 67%. Its sensitivity for thyroid cancer was lower in follicular (42%) and papillary carcinoma (64%) than medullary (100%), anaplastic (100%), secondary (100%), mixed (100%), and insular carcinomas (86%).In our series, as in the literature, most of the discordances between frozen-section and definitive diagnosis were associated with microfollicular lesions, which explain the low sensitivity of 67%. Our results demonstrate the reliability of intraoperative frozen-section analysis in thyroid surgery. Collaboration between pathologists, radiologists, and clinicians should be emphasized.

Correlation between radiological images and pathological results in supraglottic cancer

Radiological imaging plays an indispensable, complementary role to endoscopy in the pre-therapeutic assessment of laryngeal cancer. We evaluated the reliability of radiological imaging in determining the extent of cancer and surgical resection, by comparing the results of pre-operative computed tomography and magnetic resonance imaging with those for post-operative pathological analysis. Twenty-nine patients who had undergone laryngeal cancer surgery with a diagnosis of supraglottic cancer were reviewed. Imaging reliability was assessed for separate subunit regions of the supraglottic area, the glottic area and the cartilage. The false diagnosis rate for all subunits was 25 per cent. The rate of false diagnosis associated with overstaging was 21 per cent. The rate of false diagnosis associated with understaging was 4 per cent. In order to give the best chance of laryngeal preservation, especially in the case of false positive laryngeal subsites, computed tomography and magnetic resonance imaging should be combined with pre-operative endoscopy and intra-operative frozen section diagnosis.

A procedure for tissue freezing and processing applicable to both intra-operative frozen section diagnosis and tissue banking in surgical pathology

Different methods for snap freezing surgical human tissue specimens exist. At pathology institutes with higher work loads, solid carbon dioxide, freezing sprays, and cryostat freezing are commonly used as coolants for diagnosing frozen tissue sections, whereas for tissue banking, liquid nitrogen or isopentane cooled with liquid nitrogen is preferred. Freezing tissues for diagnostic and research purposes are therefore often time consuming, laborious, even hazardous, and not user friendly. In tissue banks, frozen tissue samples are stored in cryovials, capsules, cryomolds, or cryocassettes. Tissues are additionally embedded using freezing media or wrapped in plastic bags or aluminum foils to prevent desiccation. The latter method aggravates enormously further tissue handling and processing. Here, we describe an isopentane-based workflow which concurrently facilitates tissue freezing and processing for both routine intra-operative frozen section and tissue banking and satisfies the qualitative demands of pathologists, cancer researchers, laboratory technicians, and tissue bankers.

Improvement of Intraoperative Frozen Section Diagnosis in Patients with Biliary Strictures by Levovist Injection into the Bile Duct on Color Doppler Ultrasonography

This study evaluates the efficiency of color Doppler ultrasonography-guided intraoperative pancreatic biopsy (CDUS-IPB) using Levovist injected into the bile duct in conjunction with stimulated acoustic emission (SAE) in patients with biliary strictures. The study was performed on 12 patients. After completing a conventional intraoperative pancreatic biopsy (c-IPB), each subject underwent CDUS with SAE imaging using Levovist. Upon identification of the biliary stricture, the IPB was taken from the area surrounding the stricture on the same imaging setting. Section diagnosis of the CDUS-IPB specimen was compared to that of the c-IPB specimen and resected tissue. Biliary strictures were identified as enhanced areas of color Doppler signal on CDUS. CDUS-IPB provided adequate specimens from the biliary strictures in all cases and corrected false-negative diagnoses by c-IPB in three cases. Section diagnosis by CDUS-IPB corresponded to the permanent section diagnosis. There were no complications. CDUS-IPB with Levovist is an accurate diagnostic tool. The method is especially useful for patients with a suspected malignant biliary stricture who show no tumor mass in preoperative images and no evidence of malignancy on cytologic examinations.

Intra-operative frozen section diagnosis of breast lesions: a retrospective analysis of 13 243 Chinese patients

Although cytological methods for breast oncology have been used in recent decades, intra-operative frozen section has been playing a vital role in making therapeutic decisions. We analyzed a large series of frozen section diagnoses for Chinese cases of breast lesion within the last 15 years. The experience was expected to increase the diagnostic accuracy of cases with breast lesions. The data from consecutive 13243 cases of breast lesions diagnosed with intra-operative frozen sections between 1988 to 2002 were compared with paraffin sections in a case by case manner. The causes of false negative and positive diagnoses as well as delayed diagnoses were analyzed. One hundred and seventeen cases (0.9%) were falsely diagnosed, with one false positive case and 116 false negative cases. The diagnosis of 47 cases (0.4%) was delayed. The proportion of several lesions had the features of the patients' ages. Six types (false invasion, peri-papilloma, adenoma of nipple duct, florid adenosis, sclerosing adenosis, and granulose cell tumor) of lesions may lead to false positive, and four types (morphological changes responding chemotherapy, well differentiated papillary carcinoma, invasive lobular carcinoma, and tubular carcinoma) to a false negative. Gross and microscopic findings may be inconsistent in two types of lesions (radial scar and florid adenosis) microscopic and clinical findings in three types (ganulomatous mastitis mammary, duct ectasia, and fat necrosis), and three types (abundant fat or sclerous tissues; borderline lesions and changes of post-chemotherapy) were likely wrongly classified. Intra-operative frozen section can accurately identify breast lesions in many instances, leading to fewer errors on account of more diagnostic experience and understanding of diagnostic limitations.

Technique and assessment of sentinel lymph node biopsy usefulness in laparoscopy-assisted distal gastrectomy

Recently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect. The study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 ml per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed. The mean number of blue nodes dissected was 2.5 +/- 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates). The reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer.

腸閉塞をきたした回腸子宮内膜症の１例

腸管子宮内膜症は比較的稀な疾患であるが,今回イレウスで発見された回腸子宮内膜症の1例を経験したので報告する.症例は40歳,女性.腹痛を主訴に近医を受診,イレウスを繰り返し,症状が改善しないため当科紹介となった.減圧後イレウス管造影にて回腸末端近くに狭窄を認め,腹腔鏡にて観察したところ回腸末端に2カ所の狭窄病変を認め,回腸部分切除を施行した.病理組織学的に回腸子宮内膜症と診断された.開腹歴のない成熟期の女性では本疾患も鑑別疾患として考慮する必要があると思われた.

Stellenwert der intraoperativen Schnellschnittdiagnostik in der Urologie

Intraoperative frozen section diagnosis (FSD) plays an important role in urological surgery. The surgeon obtains information on suspicious tissue and can adapt his strategy for the operation, thus sparing the patient from a second intervention. Most important for a successful FSD is close co-operation between the urologist and an experienced pathologist. A very reliable assessment of urological tissues can be made with the help of FSD. The same applies for the margin status of tumours, which is most important for example in renal tumour enucleation to achieve the same oncological result as with a radical tumour nephrectomy. For the diagnosis of lymph nodes the indication for FSD depends on the urological primary lesion. Especially for prostate cancers some authors rather recommend the evaluation of the nodal status according to nomograms. FSD for "sentinel nodes" is promising but has not yet found its way into routine diagnostics.

Laparoscopic Assisted Surgical Staging using Intraoperative Frozen-Section Diagnosis in Patients with Endometrial Cancer

Objective : To report our experiences in laparoscopic assisted surgical staging (LASS) to manage the patients with endometrial cancer. Methods : From June 1997 to June 2003, we performed LASS in 31 patients with clinical stage I adenocarcinoma of the endometrium. We performed laparoscopic assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy (BSO) and intraoperative frozen-section (IFS) diagnosis. The depth of myometrial invasion, tumor differentiation, histologic types, cervical invasion, and adnexal involvement were determined by IFS diagnosis. Laparoscopic pelvic and/or para-aortic lymphadenectomies were performed based on the pathologically confirmed risk factors for nodal metastasis. Results : Fifteen patients only underwent LAVH with BSO and peritoneal washing cytology because they were identified by IFS diagnosis as low risk group for nodal metastasis. Sixteen patients had LAVH with BSO, peritoneal washing cytology and pelvic and/or para-aortic lymphadenectomies because they were identified as intermediate or high risk group. There were 15 patients with stage IA, 8 patients with stage IB, 1 patient with stage IC, 1 patient with stage IIA, 2 patients with stage IIB, 2 patients with stage IIIA and 2 patients with stage IIIB. Total length of the operation time ranged from 60 minutes to 280 minutes and the mean was 138 minutes. The mean hemoglobin decrement after the surgery was 1.3 gm/dL. One received blood transfusion. The average number of pelvic and para-aortic lymph nodes removed were 24.4 and 11.6, respectively. After the surgery, the patients passed gas after an average of 1.5 days and urinated after an average of 2.1 days. No one had serious complications after LASS. Conclusion : Based on our experiences, LASS might be an alternative to the traditional surgical approach in patients with early-stage endometrial carcinoma.

A new rapid immunohistochemical staining technique using the EnVision antibody complex.

Rapid immunohistochemical investigation, in addition to staining with hematoxylin and eosin, would be useful during intraoperative frozen section diagnosis in some cases. This study was undertaken to investigate whether the recently described EnVision system, a highly sensitive two-step immunohistochemical technique, could be modified for rapid immunostaining of frozen sections. Forty-five primary antibodies were tested on frozen sections from various different tissues. After fixation in acetone for 1 min and air-drying, the sections were incubated for 3 min each with the primary antibody, the EnVision complex (a large number of secondary antibodies and horseradish peroxidase coupled to a dextran backbone), and the chromogen (3,3'diaminobenzidine or 3-amino-9-ethylcarbazole). All reactions were carried out at 37C. Specific staining was seen with 38 antibodies (including HMB-45 and antibodies against keratin, vimentin, leukocyte common antigen, smooth muscle actin, synaptophysin, CD34, CD3, CD20, and prostate-specific antigen). A modification of the EnVision method allows the detection of a broad spectrum of antigens in frozen sections in less than 13 min. This method could be a useful new tool in frozen section diagnosis and research. (J Histochem Cytochem 49:623-630, 2001)

A CASE OF LYMPHEDEMA OF LOWER EXTEREMITY DUE TO RETROPERITONEAL FIBROSIS (ORMOND SYNDROME) WITH DIFFICULTY IN DIAGNOSIS

There have been few reports of lymphedema due to retroperitoneal fibrosis (Ormond syndrome) so far. We report such a rare case with some bibliographical comments.A 50-year-old man was seen at the hospital because of swelling of the right lower extremity, pain and hot sensation. Lymphatic scintigraphy revealed congestion of lymph of the right lower extremity. Phlegmonous inflammation caused by lymphedema was diagnosed, and administration of antibiotics and anti-inflammatory drugs, elevation of the lowe extremity, and physical therapies including Hadmer were conducted. However, the edema gradually because worse to reach the scrotum. A CT scan and magnetic resonance imaging visualized illdefined soft parts tumorous lesion along the right lateral wall of the pelvic. On imaging methods, we could not diagnose the case as inflammatory disease, retroperitoneal fibrosis, or lymphoma. So a laparotomy was performed. Intraoperative frozen section diagnosis was retroperitoneal fibrosis and then fibrous tissues were removed. Postoperative course was uneventful. The patient was discharged from the hospital after remission in swelling of the lower extremity.

Accuracy of Intraoperative Frozen-Section Diagnosis in Stage I Endometrial Adenocarcinoma

The purpose of our study was to determine if frozen-section diagnosis accurately identified patients suffering from endometrial adenocarcinoma FIGO stage I for surgical staging consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, and complete bilateral pelvic lymphadenectomy in moderately differentiated tumors with myometrial invasion. In all poorly differentiated tumors, and in all tumors with deep myometrial invasion (more than 50%) surgical staging included additional para-aortic lymphadenectomy. We performed a retrospective study including 70 patients. Frozen-section diagnosis of myometrial invasion and tumor grade was compared with permanent-section diagnosis. The accuracy rates were determined, and compared with accuracy rates of frozen-section diagnosis in the literature, and a total accuracy rate for 624 patients suffering from stage I endometrial adenocarcinoma was evaluated. In our patient collective, the overall accuracy rate of frozen-section diagnosis for myometrial invasion and tumor grade was 80 and 84%, respectively. In the five comparable studies, the mean accuracy rate for myometrial invasion and tumor grade was 89 and 84%, respectively. In combination with the five comparable studies our recent study produced an accuracy rate of frozen-section diagnosis for myometrial invasion and tumor grade of 88 and 84% in 624 patients, respectively. Despite an accuracy level of frozen-section diagnosis for myometrial invasion of 80 and 84% for tumor grade in our patient collective, all patients who required surgical staging were accurately identified.

The Accuracy of Frozen-Section Diagnosis in Metastatic Breast and Colorectal Carcinoma to the Adnexa

Objective.The objective of our study was to describe the accuracy of intraoperative frozen-section diagnosis of carcinoma metastatic to the adnexa in women with a history of breast or colorectal carcinoma.Methods.We conducted a retrospective chart review of all patients with a history of breast or colorectal carcinoma who developed histologically proven pelvic or abdominal metastases between 1988 and 1995. In those patients whose final histologic review revealed carcinoma metastatic to the adnexa, the accuracy of the intraoperative frozen-section diagnosis of the adnexal tumor was compared to the final diagnosis.Results.Forty-three patients were identified and in 36 patients the frozen section was obtained from the adnexa. Twenty-one patients (58.3%) had metastatic breast carcinoma and 15 (41.7%) had metastatic colorectal carcinoma to the adnexa. Carcinoma in the adnexa was correctly diagnosed by frozen section in 35 of 36 patients (97.2%). Metastatic carcinoma was identified at frozen section in 17 of 21 patients (81%) with metastatic breast cancer and 13 of 15 patients (86.7%) with metastatic colorectal cancer. In 3 of 21 patients (14.3%) with metastatic breast cancer and in 2 of 15 patients (13.3%) with metastatic colorectal cancer, the frozen-section diagnosis was carcinoma of uncertain origin. One patient had a false-negative frozen section because the small focus of metastatic breast cancer was not sampled at the time of frozen section.Conclusion.Intraoperative frozen-section evaluation correctly diagnosed carcinoma in the adnexa in 97% of patients, and in over 80% of cases, the carcinoma was diagnosed as being metastatic in origin.

A CASE OF ADENOCARCINOMA OF THE SMALL INTESTINE IN A YOUNG WOMAN

A case of adenocarcinoma of the small intestine in a young woman in described. A 24-year-old woman was referred to the hospital for further investigation and treatment of episodic abdominal pain. Abdominal ultrasonography demonstrated a low echoic mass adjacent to the right ovary, approximately 5×4cm in size. Small intestinal barium enema study showed a filling defect in the terminal ileum, and a colonoscopy confirmed a hemorrhagic tumor in the same region. Radical iliocecal recection with mesenteric lymph nodes dissection was performed. No tissue invasions or lymph nodes metastases were found in frozen sections intraop-eratively. The histopathological diagnosis was adenocarcinoma. The patient showed an uneventful recovery and has survived without any signs of recurrences or metastases. Malignant tumors of the small intestine are rare, especially in a young generation. In the treatment of the disease, surgical resection is mandatory, however, no definite criteria for regional lymph nodes dissection have been established as yet. We think that intraoperative frozen section diagnosis is very helpful to improve the radicality of surgery.

A CASE OF GIANT INTRACYSTIC AND NON-INVASIVE CARCINOMA OF THE MALE BREAST

A rare case of giant intracystic and non-invasive carcinoma of the male breast is reported. A 76-year-old man was seen at the hospital because of a left breast mass. A huge and hard mass, mesuring 10 by 10cm in size, was located in the entire left breast. An aspiration cytologic examination revealed class IV. A ultrasonography revealed a multi-cystic tumor and a mixed pattern. These findings offered a suspicion of breast carcinoma. An intraoperative frozen section diagnosis after tumorectomy indicated ductal carcinoma. Therefore, a modified radical mastectomy was performed. Postoperative pathological examination revealed noninvasive ductal carcinoma. He has been recurrence free for 4 months after the operation without any adjuvant therapy.

A CASE OF CANCER OF THE PAPILLA VATER CAUSING DUODENAL INTUSSUSCEPTION AFTER GASTRECTOMY

A 65-year-old man was seen at the hospital because of abdominal distension. There was a previous history of undergoing a distal gastrectomy with Billroth I method for perforation of gastric ulcer 14 years ago. Upper gastrointestinal series revealed gastrectasis of the remnant stomach. Endoscopic study revealed a cilli-ary elevated lesion at the anal side of the anastomosed site. Biopsy disclosed group III. Because of papillary proliferation of lacunar epithelium on a histologic study, it was diagnosed as stricture due to an adenoma arisen in the duodenum at anal side of anastomosed site. Upon laparotomy, a hen's egg sized tumor was present in the descending portion of duodenum which caused duodenal intussusception. Intraoperative frozen section diagnosis revealed papillary adenocarcinoma, and a pancreatoduodenectomy was performed. The definite diagnosis was carcinoma of the papilla Vater. Abdominal CT performed on the 15th month after the operation demonstrated hepatic metastasis. This operated case of papillary carcinoma showing an extremely rare growth pattern that manifested no jaundice but caused duodenal intussusception is reported.

SCLEROSING HEMANGIOMA OF THE LUNG -A CASE REPORT-

A 57-year-old woman was referred to the hospital because of abnormal circular shadow in the right middle lung on a chest-ray film at another hospital in July, 1997. A possible malignancy could not be ruled out after close examinations, and an excision of the right middle lower lobe of the lung was carried out. Intraoperative frozen section diagnosis indicated adenocarcinoma, and mediastinal lymph node dissection was added. The definitive diagnosis of sclerosing hemangioma of the lung was made based on the permanent preparation. Immunohistologically, cuboidal cells were positive for surfactant apoprotein A that is an indicator of type II alveolar epithelial cell. Although the true natures of the sclerosing hemangioma are still debatable, a recent view that regards the hemangioma as a benign tumor arising in alveolar epithelial cell has become the most convincing theory. And the immunohistological findings in this case also supported the theory.