Can pulmonary sclerosing haemangioma be accurately diagnosed by intra-operative frozen section?

Our plain-English summary of Can pulmonary sclerosing haemangioma be accurately diagnosed by intra-operative frozen section?, by A.C. Chan, J.K. Chan (Histopathology, 2002).

The study

• Authors: A.C. Chan, J.K. Chan
• Journal: Histopathology
• Published: 2002;41(5):392-403
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: Pulmonary sclerosing haemangioma is a rare benign tumour with a characteristic variegated histological pattern. In this retrospective study we aimed to identify features that can aid in making a correct diagnosis and avoiding potential pitfalls at the time of intra-operative frozen section.

Methods And Results: Twenty cases of pulmonary sclerosing haemangioma with intra-operative frozen section were reviewed. The four major histological patterns (solid, sclerotic, papillary and haemorrhagic) were found in various combinations in the frozen sections. In 17 cases, three or more patterns were present. There could be focal areas mimicking epithelioid haemangioendothelioma or carcinoid tumour. Intra-operative imprint/scrape cytology served as a helpful adjunct in confirming the cytological blandness, although occasional atypical cells could be present. An intra-operative frozen section diagnosis of 'sclerosing haemangioma' or 'benign tumour' was given in 14 cases; the diagnosis was deferred in six cases. Retrospective analysis of the deferred cases showed that a definitive intra-operative diagnosis could have been made in three, because three or more major histological patterns were present. One case showed a pure papillary pattern at frozen section, mimicking the appearance of papillary adenocarcinoma (primary or secondary), bronchioloalveolar carcinoma, epithelioid mesothelioma or papillary adenoma; two tumours from a patient with multicentric disease showed widespread significant cytological atypia in the tumours raising a serious consideration of malignancy.

Conclusion: A diagnosis of pulmonary sclerosing haemangioma can be made at intra-operative frozen sections in most cases based on the tumour circumscription and variegated histological patterns. When only a single histological pattern is identified or when there is significant cytological atypia, distinction from other tumours can be problematic, and the diagnosis is best deferred.

In plain English

This article does not concern asbestos. It was a retrospective review, from Queen Elizabeth Hospital in Hong Kong, of 20 tumours from 19 patients with pulmonary sclerosing haemangioma, a rare benign lung tumour. In each case a rapid frozen section had been requested during surgery between 1991 and 2001. All patients were female, aged 28 to 73 years. The authors re-examined the frozen section slides and intra-operative cytology smears and compared them with the final paraffin sections. During surgery, 11 cases had been reported as sclerosing haemangioma and three as benign, and the diagnosis was deferred in six (a deferral rate of 30%). In 17 cases, three or more of the tumour's four typical patterns were present. On review, three deferrals (cases 1, 13 and 15) were judged inappropriate. In one case only a papillary pattern was seen, and epithelioid mesothelioma was among the cancers considered. Two tumours from one patient showed marked cell atypia, raising a serious consideration of adenocarcinoma. The authors concluded that the tumour should be diagnosable at frozen section in most instances, and that in case of doubt it is best to defer the diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of hospital pathology cases (intra-operative frozen sections and cytology smears compared with permanent paraffin sections)
• Who was studied: 20 pulmonary sclerosing haemangioma tumours from 19 patients, all female, aged 28 to 73 years, Department of Pathology, Queen Elizabeth Hospital, Hong Kong, 1991 to 2001
• Main results:
  • At the time of surgery, 11 of the 20 cases were reported as sclerosing haemangioma and three as benign. The diagnosis was deferred in six cases, a deferral rate of 30%.
  • In 17 of the 20 cases, three or more of the four major histological patterns were present in the frozen sections.
  • On review, three of the six deferrals (cases 1, 13 and 15) were judged inappropriate, because three or more major patterns could be recognized.
  • In case 2, only a papillary pattern was seen at frozen section. Malignant possibilities, including epithelioid mesothelioma, were considered.
  • In cases 18a and 18b (two tumours from one patient), many tumour cells showed atypia, raising a serious consideration of adenocarcinoma. The diagnosis was deferred.
  • In the intra-operative cytology smears, atypical cells with enlarged and hyperchromatic nuclei were seen in six cases.
  • No additional surgery was performed in any case after the frozen section diagnosis, and the deferrals caused no adverse clinical consequence.
• The authors' conclusion: The authors concluded that pulmonary sclerosing haemangioma should be diagnosable at intra-operative frozen section in most instances, and that in case of doubt it is best to defer the diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Frozen Section, Epithelioid, Cytology, Adenocarcinoma, Carcinoma, Mesothelioma.

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