CASE REVIEW 2019-03-14 강동경희대병원 이한나.

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CASE REVIEW 2019-03-14 강동경희대병원 이한나

CASE 58/M C.C : incidentally detected abnormal finding on chest radiograph

18 months ago

A 2.7cm, well-defined nodule in the LLL, no significant interval change. -> d/dx 1) r/o) carcinoid tumor 2) r/o) sclerosing pneumocytoma

26.5 mm . 1 year later

7 years ago 6.5 years ago 16.0 mm 4.5 years ago 18months ago

Hospital course Video‑assisted thoracoscopic wedge resection (2014-08-27)

Periodic acid‑Schiff‑positive Human melanoma black (HMB)‑45

Pathologic report Lung, lower lobe, left, wedge resection: Clear cell tumor 1) size: 2.7 x 2.5 x 2.4 cm 2) mitosis: 1/50 HPFs 3) no necrosis, no atypia 4) clear resection margin [SPECIAL & IMMUNOHISTOCHEMICAL STAIN] SMA, ACTIN (Smooth Muscle) [B03] : negative CD 34 [B03] : positive CHROMOGRANIN A [B03] : negative CK, AE1/AE3 [B03] : negative EMA (Epithelial Membrane Ag) [B03] : negative KI-67 (MIB1) [B03] : about 5% Melanosome (HMB-45) [B03] : positive, focal    S-100 [B03] : positive, focal    SYNAPTOPHYSIN [B03] : negative    TTF-1 (Thyroid Transcription Factor) [B03] : negative    VIMENTIN [B03] : positive    Melanosome (HMB-45) [B04] : positive, focal    D-PAS [B04] : positive    PAS (Periodic acid Schiff) [B04] : positive

Clear cell tumor of the lung (CCTL) The family of perivascular epithelioid cell tumor (PEComa) (2004 WHO classification) Very rare benign mesenchymal tumor from perivascular epithelioid cells Consist with clear cells with a large amount of cytoplasmic PAS‑positive glycogen = sugar tumor Well-defined margin and homogenous intense enhancement Rich vascular stroma

Surgical resection for diagnosis and curative treatment Clear cell tumor of the lung (CCTL) Generally regarded as benign Malignant behavior : local invasion Possibility of malignant potential Necrosis, a mitotic index of > 1 per 50 high‐power fields, marked pleomorphism, and nuclear atypia Surgical resection for diagnosis and curative treatment

Clear cell tumor of the lung (CCTL) Difficult to identify the interval growth pattern of CCTL. In our case Initially gradual interval growth  Remained 2.7 cm for next 2.5 years Ann Thorac Surg. 2011 Feb;91(2):588-91 Gradually grow over five years 1.0cm after 12 months doubling volume time : 120days