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Dicussion
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The 10/10/04 16:02, Antonio Félix Conde say:
Primary bronchioloalveolar carcinoma of the lung versus metastatic adenocarcinoma to the lung with bronchioloalveolar pattern. The presence of nuclear grooves favours the former possibility. Nevertheless, special techniques are required to make the differential diagnosis. Greetings, Antonio F. Conde Ibiza Spain
The 10/10/04 21:18, David Cubero say:
Adenocarcinoma con patron de crecimiento bronquioloalveolar. Se necesitan los resultados de la IHQ y una imagen, aunque sea citológica del riñón para precisar. Si somos unicistas metástais de la mama. Saludos David
The 10/11/04 0:19, Sandro Casavilca say:
La vascularización y fibrosis me sugieren la posibilidad de un hemangioma esclerosante con patron adenoide, a descartar carcinoma bronquiolo alveolar. Sandro Casavilca Hospital Central de la Fuerza Aérea. Lima - Perú.
The 10/11/04 6:38, Giorgio Gherardi say:
Ciao a tutti The peripheral and subpleural location, as well as its architecture, the presence of apparently two types of cells lining the spaces (round and couboidal), and the sclerotic stroma also in my opinion suggest the so called pulmonary sclerosing hemangioma. The TTF-1+ / EMA+ / panCK- profile of the round cells would be of help to confirm this diagnosis.
The 10/11/04 7:39, Ricardo Drut say:
"Tumorcito" pulmonar (pulmonary tumorlet; proliferación neuroendocrina). Ricardo Drut.
The 10/11/04 8:06, César Ramírez say:
Hemangioma esclerosante. Saludos Complejo Hospitalario de Jaén España
The 10/11/04 9:03, Bayardo Flores say:
La lesión aparentemente es única, sin embargo, me parece que puede corresponder a una Hiperplasia Adenomatosa Atípica (Adenoma Broquioloalveolar), aunque si en la última foto las atipias parecen más graves, por lo que me es difícil afirmar que no sea ya un Adenocarcinoma. Cordiales saludos a todos. Bayardo Flores Locarno, Suiza
The 10/11/04 15:15, Larry Chen say:
The 10/11/04 21:44, Leopoldo E. Santamaria say:
Hemangioma esclerosante..
The 10/12/04 10:26, Maria Laura Fibbi say:
Io penso che si debbano prendere in considerazione almeno 2 ipotesi da verificare con immunoistochimica: 1)emangioma sclerosante 2)carcinoma bronchiolo-alveolare Dr. Maria Laura Fibbi
The 10/12/04 14:34, Dan Pankowsky say:
Good morning colleagues! I hope your day is as nice is mine is here. I think this is most likely a primary bronchioloalveolar carcinoma based on its size and location (small peripheral lesion). I would normally sign out a case like this without immunohistochemistry, but with the history of a previous breast cancer and a concurrent kidney tumor, I would do TTF-1, Ck-7, GCDPF-15, to help. Bronchioloalveolar carcinomas should be strongly TTF-1 positive. Breast and lung can by CK-7 positive but it might help rule out renal cell carcinoma. GCDPF-15 will only help if it is positive.
The 10/12/04 20:04, Vijay Singh say:
From the site, pattern and cells, I would think of Bronchoalveolar carcinoma.
The 10/13/04 8:57, emilio mayayo say:
Hola a tod@s. En el macro-micro parece que son dos los nódulos. ¿alguien se apunta a Minute Pulmonary Meningothelial-like Nodules (pequeños nódulos meningoteliomatosos pulmonares)?. Aunque me sobra el patrón vascular y me faltan técnicas. Seguimos en el foro. Enhorabuena por la aceptación y cada vez más participación internacional. Emilio
The 10/13/04 9:25, Nidhi Bhatt say:
I would go in favour of a bronchioloalveolar carcinoma of lung. However, I would like to see slides from the kidney tumor and previous breast Ca to rule out the possiblity of a metastic adenocarcinoma from either site ( papillary ca of kidney or breast)
The 10/13/04 10:00, Dr S Jivaji say:
Greetings forum members, I think this is a bronchoalveolar carcinoma. However in view of the history I would want to review the previous tumor slides from the breast and also the kidney
The 10/13/04 13:53, Túlio Geraldo de Souza e Souza say:
. Caros unineters, colocamos a sua disposição, mais duas imagens do caso, para facilitar, diagnósticos diferenciais. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dear unineters... You can see now, two new imagens of the case, that can help you in the differencial diagnosis. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Great for attencion!!! Túlio. .
The 10/13/04 15:41, Bayardo Flores say:
Las últimas fotos me inducen a retirar la propuesta de Adenoma vs. Carcinoma bronquioloalveolar. Ahora se aprecia con más claridad que la lesión está constituida por dos tipos celulares, el epitelio de revestimiento bronquiolar aparentemente no atípico e inmediatamente en posición subepitelial una población celular epitelioide con citoplasma mal definido y núcleos un tanto pleomórficos, con hendiduras (grooves), que recuerdan a células de Langerhans, aunque no pienso se trate de una histiocitosis. Con todo esto pienso que se podría agregar a las posibilidades diagnósticas ya señaladas por otros compañeros la de un Tumor Carcinoide Periférico. Seguimos errando, tal vez algún día nos toca aprender. Saludes Bayardo
The 10/14/04 19:42, sonal kulkarni say:
From the cellular arrangement & site of the lesion I would prefer the diagnosis of primary bronchoalveolar carcinoma
The 10/15/04 7:33, Maurizio Ferretti say:
Cari Colleghi, I guess the morphologic pattern allows to rule out a metastasis, both from kidney and breast carcinoma. The cubic cells we must idenify seems to growth beneath the layer of bronchiolar epithelium. Thus i think it could be a so called tumorlet. Obviously we need some diagnostic ancillary techniques (i.e. chromogranin) to reach a correct diagnosis. The second I fovour well differentiated bronchiolo alveolar carcinoma (it was my first diagnostic impression)and the third sclerosing hemangioma. Saluti a tutti Dott. Maurizio Ferretti Citopatologia Diagnostica Ospedali Riuniti di Ancona Italy
The 10/15/04 12:01, MAURIZIO SPINELLI say:
La mia prima idea è Pneumocitoma (cosiddetto Emangioma sclerosante). Saluti a tutti Maurizio Spinelli (Milano)
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Author Comment
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A neoplasia pulmonar apresenta dois tipos de células claramente distintas. As superficiais, sem as atipias esperadas no carcinoma bronquiolo alveolar. As células cúbicas, estratificadas mostram a morfologia típica das células redondas dos pneumocitomas. O primeiro tipo celular expressa TTF1, EMA, Spa, CK7 e AE1/AE3(Vide fotos adicionais). O segundo tipo expressa TTF1, CK7 e inesperadamente AE1/AE3 (Vide fotos adicionais). Este caso apresenta dois padrões: papilar e adenóide. O tumor renal é um clássico carcinoma de células claras e o tumor da mama um carcinoma ductal. Ambos sem semelhança com o tumor pulmonar.
The lung tumor has two cellular components clearly discernible. The “superficial cells” are not atypical as we expect in bronchioloalveolar carcinoma. The other cellular component is cuboidal and stratified, with the typical morphology of the “round cells” found in Pneumocytomas.
The first cellular type expresses TTF1, EMA, Spa, CK7 and AE1/AE3 (See new pictures). The second type expresses TTF1, CK7 and unexpected AE1/AE3 (See new pictures). This case show two patterns: papillary and adenoid. The kidney’s tumor is a classic clear cell carcinoma and the breast tumor a ductal carcinoma. Both without similarity with the lung tumor.
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TTF1
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Surfactante (Spa)
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References
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. 1. Devouassoux-Shisheboran M, Hayashi T, Linnoila RI, Koss MN, Travis WD. A clinicopathologic study of 100 cases of pulmonary sclerosing hemangioma with immunohistochemical studies: TTF-1 is expressed in both round and surface cells, suggesting an origin from primitive respiratory epithelium. Am J Surg Pathol. 2000 Jul;24(7):906-916. 2. Lin D, Zou S, Lu N, Liu X, Wen P, Li L. Thyroid transcription factor-1 in the histogenesis of plumonary sclerosing hemangioma. Zhonghua Zhong Liu Za Zhi. 2002 Jul;24(4):384-387. 3. Chan AC, Chan JK. Pulmonary sclerosing hemangioma consistently expresses thyroid transcription factor-1 (TTF-1): a new clue to its histogenesis. Am J Surg Pathol. 2000 Nov;24(11):1531-1536. .
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