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1/4. Multiple sclerosing hemangiomas with a 10-year history.

    We report a case of multiple sclerosing hemangiomas arising in a 38-year-old woman. Computed tomography (CT) scans of the chest showed multiple small nodules in all lobes of the right lung. The nodule sizes ranged from a few millimeters to the largest of 3.1 cm, which was located in the right middle lobe. She underwent right middle lobectomy to confirm the histological diagnosis. The resected specimen revealed multiple sclerosing hemangiomas. We followed this patient by annual chest CT scans for 10 years and demonstrated that all residual nodules remained unchanged. This is the first report of stable multiple pulmonary sclerosing hemangiomas observed for such a long period.
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2/4. Bilateral multiple pulmonary sclerosing hemangioma.

    We present herein a rare case of bilateral pulmonary sclerosing hemangioma, for which a differential diagnosis was made from metastatic lung tumors. A 32-year-old asymptomatic woman was referred to our hospital for further evaluation of abnormal chest shadows. A chest computed tomogram revealed two round, well-circumscribed masses in both sides of the lungs. Metastatic lung tumors were suspected, however, a primary lesion was not detected by several examinations. Thus, simultaneous video-assisted thoracic surgery for the bilateral tumors was performed. The tumors, measuring 16x13x12 mm in the left lung and 27x24x20 mm in the right lung, were resected, and then pathological examination confirmed the diagnosis of sclerosing hemangioma. Her postoperative course was uneventful and she has been doing well without any sign of recurrence.
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3/4. An unusual case of three synchronous tumors in a young woman.

    The occurrence in the same young patient of three synchronous tumors deriving from different embryogenic tissues and without a clear correlation with a common etiopathogenic factor is very unusual. We report a case of a Caucasian woman submitted to wide resection of a large retroperitoneal liposarcoma and right radical nephrectomy for suspected tumor infiltration. Histological examination of the right ureter and renal pelvis showed the presence of a multifocal urothelial carcinoma that was clinically asymptomatic. Two months later, during follow-up, chest X-ray and computed tomography documented a coin lesion of the upper left lung, confirmed by positron emission tomography. This nodule was surgically removed and examined histologically, resulting in a diagnosis of sclerosing hemangioma. The patient is alive without evidence of recurrent disease.
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4/4. pulmonary sclerosing hemangioma with metastasis to the mediastinal lymph node.

    During a routine health care evaluation, an abnormal shadow was detected in the chest roentgenogram of a 35-year-old man. Chest computed tomography scanning showed a nodule, approximately 3 cm in diameter, in the left S6 pulmonary segment with surrounding infiltration. bronchoscopy revealed obstruction of the left B6c bronchus by a tumor, for which biopsy was done but no definitive histologic diagnosis could be made. Then, left lower lobectomy was performed, and the tumor was diagnosed as a pulmonary sclerosing hemangioma. A mediastinal lymph node (no. 7) showed some metastatic tumor cells. As lymph node metastasis from pulmonary sclerosing hemangioma is very rare, we herein report the details of our case.
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