Recurrent haemoptysis in a young woman: a case of a malignant haemangiopericytoma of the lung.

A 36 year old woman presented with mild recurrent haemoptysis and cough persisting over several months caused by a malignant haemangiopericytoma of the right lung. Haemangiopericytomas were first described by Stout and Murray.' About half occur at a musculoskeletal site and a primary pulmonary location is rare. To date about 90 cases of pulmonary origin have been published, most of them having been compiled in two reviews .23 The degree of malignancy seems to be higher when the tumour is located in the lung. We present a case of a malignant haemangio-pericytoma in a young woman, and a short review of the current literature to stress the importance of an accurate diagnosis and the potential malignancy of this neoplasm. Case report The 36 year old non-smoking woman had noticed a dry cough and minimal haemoptysis since November 1989. Three months later she became febrile and a chest radiograph revealed inhomogeneous consolidation of the right upper lobe. After treatment with antibiotics the fever ceased, but the cough and haemopty-sis persisted. In March 1990 acid-fast myco-bacteria had grown in one sputum culture. Antituberculous chemotherapy was started and the patient was admitted to hospital. A second radiograph revealed a round, sharply defined mass 8 cm in diameter in the right upper lobe (fig 1). Bronchoscopic examination showed that the tumour was blocking the apical segment of the right upper lobe. Histological examination of biopsy samples yielded neoplastic tissue with small round and spindle shaped cells. The tumour was removed by pneumonec-tomy in May 1990. In October 1990 the patient suddenly died. At necropsy massive thrombotic embolism of the left lung was present as well as a solid metastasis weighing 290 g at the base of the pneumonectomy cavity. Non-pathogenic mycobacteria were identified from the sputum culture. The pneumonectomy specimen included a lobated 8 cm tumour infiltrating the upper lobe bronchus. Macroscopically, the pleura was intact. The tumour had a typical light microscopic appearance of a vascular pattern with small, thin walled, branched sinusoidal spaces between solid cellular areas. Reticulin and collagen fibres enmeshed the tumour cells (fig 2). Twenty five to 33 mitotic figures were found per 10 high power fields. Several necro-tic areas were located within the tumour and, at its margin, infiltration into the lung paren-chyma and the visceral pleura was present. Immunohistochemically a strongly positive reaction was found in the frozen sections for vimentin in all cells, and for factor …