Pulmonary Sclerosing Pneumocytoma and Adenocarcinoma Presenting as Two Distinct Contralateral Neoplasms in the Same Patient

Case Report

Ann Hematol Oncol. 2019; 6(4): 1242.

Pulmonary Sclerosing Pneumocytoma and Adenocarcinoma Presenting as Two Distinct Contralateral Neoplasms in the Same Patient

Oliveira T1,2, Shekhovtsova M3, Vicente P1, Miranda J4, Araújo A2,5* and Guedes F1,2

1Department Pulmonology, Centro Hospitalar Universitário do Porto, Portugal

2Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal

3Department of Anatomic Pathology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal

4Department of Cardiothoracic Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal

5Department of Medical Oncology, Centro Hospitalar Universitáário do Porto, Portugal

*Corresponding author: Araújo A, Medical Oncology Department, Centro Hospitalar Universitário do Porto, Hospital de Santo António, Porto, Portugal

Received: January 28, 2019; Accepted: March 01, 2019;Published: March 08, 2019


Pulmonary sclerosing pneumocytoma is an uncommon, benign lung tumor, which might mimic lung malignancy in terms of metabolic activity and imaging features. The authors present a case of a 65-year-old woman with two contralateral lung neoplasms: pulmonary sclerosing pneumocytoma of the right lower lobe of the lung and adenocarcinoma of the left lower lobe of the lung. The patient was treated with two contralateral lung lobectomies and adjuvant chemotherapy, remaining asymptomatic and free of neoplastic disease during the post-operative follow-up. This case intends to show the staging and prognostic implications of lung biopsy decisions in patients with multiple lung nodules or masses with identical metabolic activity.

Keywords: Pulmonary sclerosing pneumocytoma; Lung adenocarcinoma; 18F-FDG PET-CT scan; Lung cancer staging


AJCC: American Joint Committee on Cancer; B7: Medial Segment of the Right Lower Lung Lobe; CT: Computed Tomography; CK: Cytokeratin; DLCO: Diffusion Capacity of the Lung for Carbon Monoxide; ECOG-PS: Eastern Cooperative Oncology Group- Performance Status; EGFR: Epidermal Growth Factor Receptor; 18F-FDG: Fluorodeoxyglucose; KCO: Krogh Index (diffusion capacity of the lung for carbon monoxide corrected for alveolar volume); PD-L1: Programmed Death-Ligand 1; PET-CT: Positron Emission Tomography-Computed Tomography; SUV(max): maximum Standardized Uptake Value; TTF-1: Thyroid Transcription Factor-1

Case Presentation

A 65-year-old non-smoker woman, with occasional exposure to second-hand smoke and no relevant occupational inhalation exposure, ECOG-PS 0, presents to her family physician with a threemonth history of progressive exertional dyspnea and productive cough with occasional hemoptoic expectoration. Constitutional symptoms or other organ-specific symptoms were absent. Chronic gastritis, hypercholesterolemia, non-insulin-treated diabetes mellitus, hypertension and osteoarthrosis were her major comorbidities. Personal or familial history of respiratory or neoplastic diseases was absent.

Empiric antibiotic therapy, inhaled corticosteroid and longacting bronchodilators were prescribed, leading to transient clinical improvement. The patient was referred to Pneumology outpatient consultation for further urgent investigation.

Postero-anterior and left lateral chest radiographs were unremarkable. However, thoracic CT scan showed both a solid oval regular 27 mm right infra-hilar lung nodule and a heterogeneous 15 mm left hilar lung nodule (Figure 1). The remaining imaging of lung parenchyma was normal and mediastinal or pleural involvement were absent.