Malignant pulmonary epithelioid hemangioendothelioma with hilar lymph node metastasis

Naobumi Tochigi, Koji Tsuta, Akiko Miyagi Maeshima, Yasuo Shibuki, Hisao Asamura, Tadashi Hasegawa, Hitoshi Tsuda

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Few cases each of malignant pulmonary epithelioid hemangioendothelioma (PEH) and PEH with lymph node metastasis have been reported. Here we report a case of PEH with lymph node metastasis. A Japanese woman was found to have a 2-cm-diameter mass with small satellite nodules in the right upper lobe of the lung. Microscopic examination revealed solid destructive growth of the main tumor, with epithelioid cells showing cytologic atypia and 3 mitotic figures per 10 high-power fields. Some of the tumor cells had intracytoplasmic lumina that appeared as vacuoles. These lumina were negative for alcian blue and periodic acid Schiff, and contained erythrocytes. However, erythrocytes were seen more frequently within small but distinct vascular channels that were arranged diffusely in the periphery of the main tumor. Other satellite nodules showed conventional PEH morphology. In hilar lymph nodes, the tumor cells resembled those of the main tumor. The vascular origin of the main tumor and satellite nodules was demonstrated by positive immunoreactivity for some endothelial markers. Although the diagnostic features of malignant PEH are not clear, those for PEH in other organs have included nuclear atypia, many mitoses, presence of necrosis, large tumor size, and spindle cell proliferation. The present case met these criteria, except for large tumor size and spindle cell proliferation. In conclusion, atypical cytologic features, the presence of necrosis, a high Ki-67 labeling index, and accompanying nodules of conventional PEH in the same pulmonary lobe suggest that this case was a malignant PEH with hilar lymph node metastasis.

Original languageEnglish
Pages (from-to)207-212
Number of pages6
JournalAnnals of Diagnostic Pathology
Volume15
Issue number3
DOIs
Publication statusPublished - 2011 Jun
Externally publishedYes

Fingerprint

Epithelioid Hemangioendothelioma
Lymph Nodes
Neoplasm Metastasis
Lung
Neoplasms
Blood Vessels
Necrosis
Erythrocytes
Cell Proliferation
Epithelioid Cells
Alcian Blue
Periodic Acid
Vacuoles
Mitosis

Keywords

  • Diagnosis
  • Immunohistochemistry
  • Lymph node
  • Malignant
  • Pulmonary epithelioid hamangioendothelioma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Malignant pulmonary epithelioid hemangioendothelioma with hilar lymph node metastasis. / Tochigi, Naobumi; Tsuta, Koji; Maeshima, Akiko Miyagi; Shibuki, Yasuo; Asamura, Hisao; Hasegawa, Tadashi; Tsuda, Hitoshi.

In: Annals of Diagnostic Pathology, Vol. 15, No. 3, 06.2011, p. 207-212.

Research output: Contribution to journalArticle

Tochigi, Naobumi ; Tsuta, Koji ; Maeshima, Akiko Miyagi ; Shibuki, Yasuo ; Asamura, Hisao ; Hasegawa, Tadashi ; Tsuda, Hitoshi. / Malignant pulmonary epithelioid hemangioendothelioma with hilar lymph node metastasis. In: Annals of Diagnostic Pathology. 2011 ; Vol. 15, No. 3. pp. 207-212.
@article{73c1d89c14d24540a15313f8b711b800,
title = "Malignant pulmonary epithelioid hemangioendothelioma with hilar lymph node metastasis",
abstract = "Few cases each of malignant pulmonary epithelioid hemangioendothelioma (PEH) and PEH with lymph node metastasis have been reported. Here we report a case of PEH with lymph node metastasis. A Japanese woman was found to have a 2-cm-diameter mass with small satellite nodules in the right upper lobe of the lung. Microscopic examination revealed solid destructive growth of the main tumor, with epithelioid cells showing cytologic atypia and 3 mitotic figures per 10 high-power fields. Some of the tumor cells had intracytoplasmic lumina that appeared as vacuoles. These lumina were negative for alcian blue and periodic acid Schiff, and contained erythrocytes. However, erythrocytes were seen more frequently within small but distinct vascular channels that were arranged diffusely in the periphery of the main tumor. Other satellite nodules showed conventional PEH morphology. In hilar lymph nodes, the tumor cells resembled those of the main tumor. The vascular origin of the main tumor and satellite nodules was demonstrated by positive immunoreactivity for some endothelial markers. Although the diagnostic features of malignant PEH are not clear, those for PEH in other organs have included nuclear atypia, many mitoses, presence of necrosis, large tumor size, and spindle cell proliferation. The present case met these criteria, except for large tumor size and spindle cell proliferation. In conclusion, atypical cytologic features, the presence of necrosis, a high Ki-67 labeling index, and accompanying nodules of conventional PEH in the same pulmonary lobe suggest that this case was a malignant PEH with hilar lymph node metastasis.",
keywords = "Diagnosis, Immunohistochemistry, Lymph node, Malignant, Pulmonary epithelioid hamangioendothelioma",
author = "Naobumi Tochigi and Koji Tsuta and Maeshima, {Akiko Miyagi} and Yasuo Shibuki and Hisao Asamura and Tadashi Hasegawa and Hitoshi Tsuda",
year = "2011",
month = "6",
doi = "10.1016/j.anndiagpath.2010.02.012",
language = "English",
volume = "15",
pages = "207--212",
journal = "Annals of Diagnostic Pathology",
issn = "1092-9134",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Malignant pulmonary epithelioid hemangioendothelioma with hilar lymph node metastasis

AU - Tochigi, Naobumi

AU - Tsuta, Koji

AU - Maeshima, Akiko Miyagi

AU - Shibuki, Yasuo

AU - Asamura, Hisao

AU - Hasegawa, Tadashi

AU - Tsuda, Hitoshi

PY - 2011/6

Y1 - 2011/6

N2 - Few cases each of malignant pulmonary epithelioid hemangioendothelioma (PEH) and PEH with lymph node metastasis have been reported. Here we report a case of PEH with lymph node metastasis. A Japanese woman was found to have a 2-cm-diameter mass with small satellite nodules in the right upper lobe of the lung. Microscopic examination revealed solid destructive growth of the main tumor, with epithelioid cells showing cytologic atypia and 3 mitotic figures per 10 high-power fields. Some of the tumor cells had intracytoplasmic lumina that appeared as vacuoles. These lumina were negative for alcian blue and periodic acid Schiff, and contained erythrocytes. However, erythrocytes were seen more frequently within small but distinct vascular channels that were arranged diffusely in the periphery of the main tumor. Other satellite nodules showed conventional PEH morphology. In hilar lymph nodes, the tumor cells resembled those of the main tumor. The vascular origin of the main tumor and satellite nodules was demonstrated by positive immunoreactivity for some endothelial markers. Although the diagnostic features of malignant PEH are not clear, those for PEH in other organs have included nuclear atypia, many mitoses, presence of necrosis, large tumor size, and spindle cell proliferation. The present case met these criteria, except for large tumor size and spindle cell proliferation. In conclusion, atypical cytologic features, the presence of necrosis, a high Ki-67 labeling index, and accompanying nodules of conventional PEH in the same pulmonary lobe suggest that this case was a malignant PEH with hilar lymph node metastasis.

AB - Few cases each of malignant pulmonary epithelioid hemangioendothelioma (PEH) and PEH with lymph node metastasis have been reported. Here we report a case of PEH with lymph node metastasis. A Japanese woman was found to have a 2-cm-diameter mass with small satellite nodules in the right upper lobe of the lung. Microscopic examination revealed solid destructive growth of the main tumor, with epithelioid cells showing cytologic atypia and 3 mitotic figures per 10 high-power fields. Some of the tumor cells had intracytoplasmic lumina that appeared as vacuoles. These lumina were negative for alcian blue and periodic acid Schiff, and contained erythrocytes. However, erythrocytes were seen more frequently within small but distinct vascular channels that were arranged diffusely in the periphery of the main tumor. Other satellite nodules showed conventional PEH morphology. In hilar lymph nodes, the tumor cells resembled those of the main tumor. The vascular origin of the main tumor and satellite nodules was demonstrated by positive immunoreactivity for some endothelial markers. Although the diagnostic features of malignant PEH are not clear, those for PEH in other organs have included nuclear atypia, many mitoses, presence of necrosis, large tumor size, and spindle cell proliferation. The present case met these criteria, except for large tumor size and spindle cell proliferation. In conclusion, atypical cytologic features, the presence of necrosis, a high Ki-67 labeling index, and accompanying nodules of conventional PEH in the same pulmonary lobe suggest that this case was a malignant PEH with hilar lymph node metastasis.

KW - Diagnosis

KW - Immunohistochemistry

KW - Lymph node

KW - Malignant

KW - Pulmonary epithelioid hamangioendothelioma

UR - http://www.scopus.com/inward/record.url?scp=79955912802&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955912802&partnerID=8YFLogxK

U2 - 10.1016/j.anndiagpath.2010.02.012

DO - 10.1016/j.anndiagpath.2010.02.012

M3 - Article

VL - 15

SP - 207

EP - 212

JO - Annals of Diagnostic Pathology

JF - Annals of Diagnostic Pathology

SN - 1092-9134

IS - 3

ER -