Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan.
Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan.
Pathol Int. 2020 Aug;70(8):568-573. doi: 10.1111/pin.12945. Epub 2020 May 5.
Solitary pulmonary capillary hemangiomas (SPCHs) are recently recognized, rare benign lesions that form solitary nodules owing to capillary proliferation. These lesions are usually detected incidentally as small ground-glass nodules (GGNs) on computed tomography (CT), and progressively enlarge over time. The radiological distinction from peripheral lung cancers is particularly challenging. However, to date, there have been no reports on progressive changes in the central density of SPCH on CT. An asymptomatic 49-year-old man was referred to our hospital for an abnormal shadow that was detected on chest CT during medical check-up. He was subsequently followed-up with chest CT. The nodule increased in size, and the central area became progressively denser. He underwent surgery 5 years and 10 months after the first visit owing to suspicion of lung cancer. Despite the collapse of the surgical specimen by artifacts, histopathological examination revealed a diagnosis of SPCH; collagenous fibers were found in the walls of the intralesional capillaries. The patient is presently alive without any recurrence, 6 months after the operation. In this case, the SPCH demonstrated a GGN with progressively increasing density of the central solid area on the CT. This remarkable feature made the preoperative distinction from lung cancer particularly difficult.
孤立性肺毛细血管血管瘤（SPCH）是新近认识的一种罕见良性病变，因毛细血管增生而形成孤立性结节。这些病变通常在计算机断层扫描（CT）上作为小的磨玻璃结节（GGN）偶然被发现，并随时间逐渐增大。与周围型肺癌的影像学鉴别特别具有挑战性。然而，迄今为止，还没有关于 CT 上 SPCH 中央密度进行性变化的报道。一名 49 岁无症状男性因体检时胸部 CT 发现异常阴影而被转诊至我院。随后他接受了胸部 CT 随访。结节增大，中央区域密度逐渐增高。由于怀疑肺癌，他在首次就诊后 5 年 10 个月接受了手术。尽管手术标本因伪影而塌陷，但组织病理学检查显示 SPCH 的诊断；在病灶内毛细血管的壁内发现胶原纤维。术后 6 个月，患者无复发，目前仍存活。在本例中，SPCH 在 CT 上表现为具有逐渐增加的中央实性区域密度的 GGN。这一显著特征使得术前与肺癌的鉴别特别困难。
