Pathology of Lung Disease by Helmut Popper

Author:Helmut Popper
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Differential Diagnosis

Inflammatory pseudotumor, clear cell “sugar” tumor (PECOMA), some primary and metastatic carcinomas, and low-grade epithelioid hemangioendothelioma have been considered as probable differentials. Inflammatory pseudotumor usually can easily be separated, because of the mixture of plasma cells, myofibroblasts, smooth muscle cells, as well as histiocytes. Even pure histiocytic variants will morphologically look differently. The clear cell tumor might look similar but will not present with the two cell types mentioned above. Epithelioid hemangioendothelioma might give problems in the differential diagnosis: the sclerotic areas can look similar, hemorrhage is sometimes present, but the pseudo-signet ring cell appearance of the tumor cells within sclerotic areas will usually guide one toward the correct diagnosis. A positive reaction for surfactant apoprotein A and a negative one for endothelial markers will help in making the right diagnosis. Primary and metastatic carcinomas can look similar to sclerosing pneumocytoma – this is especially true for metastatic lobular breast and prostate carcinomas. Since nuclear atypia and mitotic counts are not immediately apparent, immunohistochemical stains might be necessary.

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