1
|
Savu C, Melinte A, Gibu A, Varban S, Diaconu C, Stiru O, Balescu I, Bacalbasa N. Pulmonary Mucinous Cystadenoma - A Rare Pathology. In Vivo 2021; 35:629-634. [PMID: 33402519 DOI: 10.21873/invivo.12301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pulmonary cystadenoma is a very rare benign tumor of the lung with slow growth rate and most often, asymptomatic. CASE REPORT We present the case of a 58-year-old patient admitted in the hospital for coughing with hemoptoic sputum. Standard thoracic radiography revealed a 4/5 cm macronodular opacity in the right inferior lobe, paracardiac. Thoracic computed tomography (CT) with contrast discovered a 3.8/4.7 cm homogenous mass in the right inferior lobe. After intraoperative assessment of the lesion a lower right lobectomy with mediastinal and local lymphadenectomy was performed. CONCLUSION Pulmonary mucinous cystadenoma is one of the primary pulmonary mucinous cystic neoplasia (PMCT) alongside PMCT of low malignancy and pulmonary mucinous cystadenocarcinoma (PMCAC). Because of this and because of the clinical and imagistic similarities between these main entities, establishing a preoperative diagnosis becomes very difficult. Therefore, histopathological and immunohistochemistry studies are mandatory in order to establish the correct diagnosis.
Collapse
Affiliation(s)
- Cornel Savu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania.,Department of Thoracic Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandru Melinte
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Alexandru Gibu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Stefania Varban
- Department of Pathology, "Marius Nasta" National Institute of Pneumology, Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, "Prof. Dr. C. C. Iliescu" Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.,Department of Cardiovascular Surgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, "Ponderas" Academic Hospital, Bucharest, Romania;
| | - Nicolae Bacalbasa
- Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
2
|
Todhe P, Sharma N, Shetty A, Ochieng P. Pulmonary mucinous cystadenocarcinoma: an unusual presentation and literature review. BMJ Case Rep 2020; 13:13/7/e235567. [PMID: 32675126 DOI: 10.1136/bcr-2020-235567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
Cystic lung disease is a group of heterogeneous pulmonary diseases resulting from hereditary/congenital disorders, systemic disorders and infectious causes among others. Pulmonary mucinous cystic neoplasia is a spectrum of neoplastic cystic diseases with abundant mucin, of which pulmonary mucinous cystadenocarcinoma (PMC) is a rare malignant subtype. We present a case of a 66-year-old man who presented with dyspnoea, cough, fatigue and weight loss. Imaging of his chest showed numerous cavitary lesions, and the diagnosis of PMC was made based on lung biopsy. He received palliative chemotherapy and died 1 year later. We present a literature review of PMC based on 26 reported cases, including our own.
Collapse
Affiliation(s)
- Pandi Todhe
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Nishant Sharma
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Ajay Shetty
- Department of Pulmonary and Critical Care Medicine, Geisinger Community Medical Center, Scranton, Pennsylvania, USA
| | - Pius Ochieng
- Department of Pulmonary and Critical Care Medicine, Geisinger Community Medical Center, Scranton, Pennsylvania, USA
| |
Collapse
|
3
|
Clinicopathologic analysis of 10 cases of pulmonary colloid adenocarcinoma and prognostic implication of invasive micropapillary component. Pathol Res Pract 2018; 214:2093-2098. [DOI: 10.1016/j.prp.2018.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/17/2018] [Accepted: 10/19/2018] [Indexed: 12/28/2022]
|
4
|
Abstract
OBJECTIVE We aimed to assess CT and 18F-FDG PET/CT findings of colloid adenocarcinoma of the lung in seven patients. MATERIALS AND METHODS From 2010 to 2017, seven patients with surgically proven colloid adenocarcinoma of the lung were identified. CT (both enhanced and unenhanced) and PET/CT findings were analyzed, and the imaging features were compared with histopathologic reports. Clinical and demographic features were also analyzed. RESULTS In all cases except one, tumors showed low attenuation on unenhanced CT scans, ranging in attenuation from -16.5 to 20.7 HU (median, 9.2 HU). After contrast medium injection, enhancement was scant, so net enhancement ranged from 0.4 to 29.0 HU (median, 4.1 HU). All tumors had a lobulated contour. Stippled calcifications within the tumor were seen in one patient. The maximum standardized uptake value of tumors on PET/CT ranged from 1.5 to 4.5 (median, 3.5). In six of seven patients, FDG accumulation was seen in the tumor walls (n = 3, curvilinear uptake) or in both the tumor walls and tumor septa (n = 3, crisscross uptake). Six patients were alive without recurrence after a median follow-up period of 2.3 years (range, 2 months to 5 years). In one patient, who was alive at follow-up 4 years after imaging and had received adjuvant concurrent chemoradiation therapy after lobectomy, recurrent disease was detected 6 months after completion of the therapy. CONCLUSION On CT, pulmonary colloid adenocarcinomas present as lobulated homogeneously low-attenuation tumors. At PET, curvilinear or crisscross FDG uptake is seen within the tumor where tumor cells are lining the walls or septal structures.
Collapse
|
5
|
Christianson BE, Gupta S, Vyas SG, Spartz H, Keshavamurthy JH. A diagnostic challenge: An incidental lung nodule in a 48-year-old nonsmoker. Lung India 2018; 35:251-255. [PMID: 29697085 PMCID: PMC5946561 DOI: 10.4103/lungindia.lungindia_212_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
A 43-year-old female with a medical history of renal stones, hypertension, diabetes mellitus Type 2, and depression presented to her urologist with bilateral flank pain. She complained of worsening exertional dyspnea over the last several months with recent weight gain. She also endorsed night sweats and intermittent, scant hemoptysis over the past year. She denied fever, chills, nausea, vomiting, diarrhea, constipation, hematuria, or excessive joint or muscle pain. Physical examination was unremarkable. Computed tomography scan of abdomen and pelvis demonstrated bilateral nonobstructing renal stones and a 1.8 cm × 1.7 cm nodular opacity in the right lower lobe of the lung, not present on previous scan 1 year prior. Surgical wedge resection was performed and subsequent pathologic examination demonstrated a 1.2 cm × 0.6 cm × 0.5 cm soft, gelatinous well-demarcated mass in the right lower lobe wedge specimen without gross evidence of necrosis or hemorrhage confirming colloid adenocarcinoma of the lung.
Collapse
Affiliation(s)
| | - Supriya Gupta
- Department of Radiology, Medical College of Georgia, Augusta, GA, USA
| | - Shikhar G Vyas
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA
| | - Helena Spartz
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA
| | | |
Collapse
|
6
|
Moneke I, Zeisel C, Elze M, Haager B, Passlick B, Kayser G. Mucinous cystadenocarcinoma arising from mucinous cystadenoma of the lung: case report and review of the literature. J Thorac Dis 2018; 10:E243-E249. [PMID: 29850162 DOI: 10.21037/jtd.2018.04.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mucinous cystadenoma is a benign tumor commonly found in the pancreas, the ovaries or the appendix. Only very few cases of these tumors originating from the lungs have been reported worldwide, with even less cases describing malignant transformation. We present the case of a 58-year-old woman with a history of recurrent pulmonary infections who underwent left upper lobectomy for lung abscess and was initially diagnosed with pulmonary mucinous cystadenoma (PMCA). Upon thorough immunohistochemical workup, especially due to carcinoembryonic antigen (CEA) positivity, intramucinous singlet cells were eventually diagnostic for invasive carcinoma, in this case a mucinous cystadenocarcinoma arising from a PCMA. PMCA is a rare benign tumor whose potential for malignant transformation has not yet been fully understood. Due to the low number of cases further studies are needed to evaluate if there is a benefit of complete oncologic resection, provided the general condition of the patient allows it. A review of the currently available literature serves to better understand the clinical, radiological and histological features of this rare tumor.
Collapse
Affiliation(s)
- Isabelle Moneke
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Division "Cancer Research", Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christoph Zeisel
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Elze
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt Haager
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gian Kayser
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Surgical Pathology, Department of Pathology, Medical Center-University of Freiburg, Freiburg, Germany
| |
Collapse
|
7
|
Shannon VR, Nanda AS, Middleton LP, Faiz SA. Pulmonary Mucinous Cystadenocarcinoma Presenting as Extensive Multifocal Cystic Lesions. Am J Respir Crit Care Med 2017; 195:1267-1268. [PMID: 28199793 DOI: 10.1164/rccm.201610-2106im] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Amit S Nanda
- 2 University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
| | - Lavinia P Middleton
- 3 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | | |
Collapse
|
8
|
Youngren-Ortiz SR, Hill DB, Hoffmann PR, Morris KR, Barrett EG, Forest MG, Chougule MB. Development of Optimized, Inhalable, Gemcitabine-Loaded Gelatin Nanocarriers for Lung Cancer. J Aerosol Med Pulm Drug Deliv 2017; 30:299-321. [PMID: 28277892 PMCID: PMC5650720 DOI: 10.1089/jamp.2015.1286] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Aerosol delivery of chemotherapeutic nanocarriers represents a promising alternative for lung cancer therapy. This study optimized gemcitabine (Gem)-loaded gelatin nanocarriers (GNCs) cross-linked with genipin (Gem-GNCs) to evaluate their potential for nebulized lung cancer treatment. METHODS Gem-GNCs were prepared by two-step desolvation and optimized through Taguchi design and characterized for physicochemical properties. Particle size and morphology were confirmed by scanning and transmission electron microscopy. In vitro release of Gem from Gem-GNCs performed in Dulbecco's phosphate-buffered saline and simulated lung fluid was evaluated to determine release mechanisms. Particle size stability was assessed under varying pH. Differential scanning calorimetry and powder X-ray diffraction were used to determine the presence and stability of Gem-GNC components and amorphization of Gem, respectively. Gem-GNC efficacy within A549 and H460 cells was evaluated using MTT assays. Mucus rheology upon treatment with Gem-GNCs, lactose, and normal saline control was measured. Andersen cascade impaction identified the aerodynamic particle size distribution of the nebulized formulation. RESULTS Gem-GNCs had particle size, zeta potential, entrapment efficiency, and loading efficiency of 178 ± 7.1 nm, -18.9 mV, 92.5%, and 9.1%, respectively. The Gem and formulation excipients where molecularly dispersed and configured amorphously. Gem-GNCs were stable at pH 5.4-7.4 for 72 hours. Gem release from Gem-GNCs was governed by non-Fickian controlled release due to diffusion/erosion from a matrix-based nanocarrier. Gem-GNCs elicited a 40% reduction of the complex viscosity η*(1 Hz) of human bronchial epithelial cell mucus containing 3 wt% solids to mimic mild airway disease. The nebulized Gem-GNCs had a mass median aerodynamic diameter (MMAD) of 2.0 ± 0.16 μm, geometric standard deviation (GSD) of 2.7 ± 0.16, and fine particle fraction (FPF) of 75.2% ± 2.4%. The Gem-GNC formulation did not outperform the Gem solution in A549 cells. However, in H460, Gem-GNCs outperformed the Gem IC50 reduction by ∼5-fold at 48 and 10-fold 72 hours. CONCLUSION Stable, effective, and sustained-release Gem-GNCs were developed. The nebulized Gem-GNCs had satisfactory MMAD, GSD, and FPF and the formulation reduced the dynamic complex viscosity of mucus consistent with increased mobility of nanoparticles.
Collapse
Affiliation(s)
- Susanne R. Youngren-Ortiz
- Translational Drug Delivery Research (TransDDR) Laboratory, Department of Pharmaceutical Sciences, The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, Hawai'i
| | - David B. Hill
- Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Marsico Lung Institute/CF Center, The University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Peter R. Hoffmann
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i
| | - Kenneth R. Morris
- Translational Drug Delivery Research (TransDDR) Laboratory, Department of Pharmaceutical Sciences, The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, Hawai'i
- The Lachman Institute for Pharmaceutical Analysis, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University–Brooklyn Campus, Brooklyn, New York
| | - Edward G. Barrett
- Respiratory and Asthma Program, Lovelace Respiratory Research Institute, Albuquerque, New Mexico
| | - M. Gregory Forest
- Carolina Center for Interdisciplinary Applied Mathematics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mahavir B. Chougule
- Translational Drug Delivery Research (TransDDR) Laboratory, Department of Pharmaceutical Sciences, The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, Hawai'i
- Pii Center for Pharmaceutical Technology, Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, Mississippi
- Translational Drug and Gene Delivery Research (TransDGDR) Laboratory, Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, Mississippi
- Natural Products and Experimental Therapeutics Program, University of Hawai'i Cancer Center, University of Hawai'i, Honolulu, Hawai'i
| |
Collapse
|
9
|
Popper HH. Cons: the confusing mucinous adenocarcinoma classification. Transl Lung Cancer Res 2017; 6:234-240. [PMID: 28529906 PMCID: PMC5420532 DOI: 10.21037/tlcr.2017.04.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/19/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Helmut H Popper
- Research Unit Molecular Lung & Pleura Pathology, Institute of Pathology, Medical University Graz, Graz, Austria
| |
Collapse
|
10
|
Mixed epithelial and stromal tumor of the middle ear. Hum Pathol 2017; 61:199-204. [DOI: 10.1016/j.humpath.2016.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/01/2016] [Accepted: 09/23/2016] [Indexed: 12/16/2022]
|
11
|
Masai K, Sakurai H, Suzuki S, Asakura K, Nakagawa K, Watanabe SI. Clinicopathological features of colloid adenocarcinoma of the lung: A report of six cases. J Surg Oncol 2016; 114:211-5. [DOI: 10.1002/jso.24302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/05/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Kyohei Masai
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Hiroyuki Sakurai
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Shigeki Suzuki
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Keisuke Asakura
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| |
Collapse
|
12
|
Chand T, Rosha D, Agarwal K, Kashyap V. Mucinous cyst adenocarcinoma of lung presented with recurrent pneumothorax. Lung India 2016; 33:101-3. [PMID: 26933322 PMCID: PMC4748645 DOI: 10.4103/0970-2113.173082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Affiliation(s)
- Trilok Chand
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Deepak Rosha
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Kanika Agarwal
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Vikas Kashyap
- Department of Pathology, Indraprastha Apollo Hospitals, New Delhi, India E-mail:
| |
Collapse
|
13
|
Kalkanis A, Palaiodimos L, Klinaki I, Karantanis D, Kalkanis D. 18F-FDG PET/CT Imaging of Pulmonary Mucinous Cystadenocarcinoma with Signet Ring Cells. Nucl Med Mol Imaging 2016; 51:277-280. [PMID: 28878858 DOI: 10.1007/s13139-016-0402-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 01/16/2016] [Accepted: 01/26/2016] [Indexed: 11/30/2022] Open
Abstract
A 63-year-old male with a recently diagnosed right lung lesion was referred for staging. F-FDG PET/CT scan revealed a hypodense, cystic-like mass in the right upper lung lobe, which demonstrated low, diffuse 18F-FDG uptake, likely due to the presence of mucus, as well as intensely hypermetabolic right hilar and right paratracheal lymph nodes. Transbronchial biopsy revealed a primary pulmonary mucinous cystadenocarcinoma with the presence of signet ring cell carcinoma, a co-existence of two rare variants of lung adenocarcinoma. This case report demonstrates the metabolic phenotype along with the radiographic characteristics of this rare tumor and its metastases.
Collapse
Affiliation(s)
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center / Albert Einstein College of Medicine, 1955 Williamsbridge Road, Bronx, NY 10461 USA
- Society of Junior Doctors, Athens, Greece
| | - Ifigeneia Klinaki
- Department of Nuclear Medicine, Biotypos Diagnostic Center, Athens, Greece
| | | | - Dimitrios Kalkanis
- Department of Nuclear Medicine, 251 Greek Airforce Hospital, Athens, Greece
| |
Collapse
|
14
|
Zenali MJ, Weissferdt A, Solis LM, Ali S, Tang X, Mehran RJ, Wistuba II, Moran CA, Kalhor N. An update on clinicopathological, immunohistochemical, and molecular profiles of colloid carcinoma of the lung. Hum Pathol 2015; 46:836-42. [PMID: 25776025 DOI: 10.1016/j.humpath.2014.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
Colloid carcinoma is a rare subtype of lung adenocarcinoma characterized by abundant pools of extracellular mucin and scant malignant epithelium. Because of the rarity of these tumors, many of the reported clinicopathological and immunohistochemical characteristics are contradictory. Moreover, the molecular alterations that underlie these tumors are unknown. We present the clinicopathological, immunohistochemical, and molecular features of 13 cases of colloid carcinoma of the lung. The patients were 9 women and 4 men between the ages of 48 and 86 years. Surgical resection and staging were performed in all patients. Seven patients were in stage T1N0M0, 3 in T2N0M0, 2 in T2N1M0, and 1 in T2N0M1. The tumor was 100% mucinous in 9 patients, whereas in 4 cases, the lesions consisted of 50% to 90% mucin pools with the remainder being a noncolloid adenocarcinoma component ranging in morphology from bronchioalveolar to acinar, papillary, solid, or mixed patterns. Follow-up ranged from 35 to 128 months. Three patients died, 1 of disease and 2 of unrelated causes. The remaining 10 patients are alive at the time of reporting, 3 with recurrent disease. Immunohistochemical studies showed CK7, CK20, and CDX2 expression in all tumors, whereas TTF-1, surfactant A, and napsin A were not present or were only focally positive in most cases. Analysis showed KRAS mutations in 2 cases. All tumors were negative for ALK gene rearrangement and EGFR mutation. Our study highlights the clinicopathological, immunohistochemical, and molecular features of lung colloid adenocarcinoma and attempts to clarify some misconceptions regarding this rare tumor.
Collapse
Affiliation(s)
- Maryam J Zenali
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Luisa M Solis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Sara Ali
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Ximing Tang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Ignacio I Wistuba
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Cesar A Moran
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030.
| |
Collapse
|
15
|
Jessurun J. Intra-Alveolar Intestinal Epithelium: A Reappraisal of the So-Called Mucinous Goblet-Cell Rich Carcinoma Apropos of Two Cases With Prolonged Follow-up and Literature Review. Int J Surg Pathol 2015; 23:196-201. [PMID: 25627070 DOI: 10.1177/1066896915568992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary pulmonary mucin-rich lesions with abundant goblet cells growing within alveolar spaces are either classified as mucinous adenocarcinoma (previously called mucinous bronchioloalveolar carcinoma) or colloid carcinoma. Some of these lesions display a morphologic pattern characterized by paucicellular discontinuous patches of nonatypical colonic type epithelium attached to alveolar walls without evidence of invasion. Immunohistochemically, these epithelial patches express an intestinal immunophenotype (CD20+, CDX-2+, CK7-, TTF-1-). None of the lesions so far reported with these histological and immunohistochemical characteristics have recurred or metastasized. Herein we describe 2 patients with this type of intra-alveolar mucinous lesions who have been meticulously followed-up for 9 and 14 years, respectively, without evidence of disease progression. Based on their histologic appearance, immunoreactivity, and on the presence of occasional CDX-2 expressing cells in terminal airways adjacent to the lesions, we propose alternative interpretations of the mucin-producing epithelium. More important, a separate provisional category for these lesions is suggested that eliminates their force inclusion as adenocarcinomas.
Collapse
Affiliation(s)
- Jose Jessurun
- New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| |
Collapse
|
16
|
Abstract
We describe a rare case of pulmonary mucinous cystadenoma (PMCA) detected F-FDG PET/CT and mimicking a malignancy. A 60-year-old female patient underwent F-FDG PET/CT for metabolic characterization of a left pulmonary nodule which showed increased F-FDG uptake (SUVmax = 3.7). Based on this PET/CT finding, the patient underwent a cuneiform resection of the left pulmonary nodule. Histology demonstrated the presence of a PMCA. In our case, F-FDG PET/CT has been useful in detecting this rare pulmonary tumor.
Collapse
|
17
|
Kassir R, Forest F, Kaczmarek D. Pulmonary mucinous cystadenocarcinoma presenting as a pleural mesothelioma. Int J Surg Case Rep 2013; 4:942-4. [PMID: 24055913 PMCID: PMC3825993 DOI: 10.1016/j.ijscr.2013.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Primary Pulmonary Mucinous Cystadenocarcinoma PPMC is an extremely rare subtype of pulmonary adenocarcinoma, with only a few dozen cases reported in the literature to date. PRESENTATION OF CASE We report a extremely rare case of pulmonary mucinous cystadenocarcinoma presenting as a pleural mesothelioma. 53-year-old man exposed to asbestos, he is admitted in hospital with a 5 cm mass in right pleura. He was treated by wedge resection. Sparse groups of malignant cells were microscopically observed in pools of mucin. The postoperative histopathological findings were in accordance with the diagnosis of pulmonary mucinous cystadenocarcinoma on cystic adenoid malformation of lung. 5 years later, the patient has no recurrence. DISCUSSION PPMC is usually asymptomatic; hemoptysis is seen occasionally. Preoperative diagnosis is very difficult to establish. Both FNA cytology and transbronchial lung biopsy seem inadequate. Our patient went on to undergo open lung biopsy and histopathological testing that confirmed the diagnosis of PMC. CONCLUSION It is important to differentiate this rare pathological feature of the lung from other lung tumors as the treatment is surgical rather than medical. Thoracic surgeons should bear in mind this rare tumor for the differential diagnosis of a pleural mesothelioma because this tumor has a favorable prognosis.
Collapse
Affiliation(s)
- Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Etienne, France.
| | | | | |
Collapse
|
18
|
Michaud CR, Ragland DR, St Claire MC, Elkins WR, Gozalo AS. Mucinous cystadenoma in the lung of a captive-born moustached tamarin (Saguinus mystax). J Comp Pathol 2013; 149:376-80. [PMID: 23356933 PMCID: PMC3640675 DOI: 10.1016/j.jcpa.2012.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 10/26/2012] [Accepted: 12/04/2012] [Indexed: 11/17/2022]
Abstract
A 2-year-old, captive-born, male moustached tamarin was subjected to necropsy examination after a fatal head trauma. A solitary, circumscribed, subpleural mass (0.6 cm diameter) was found in the right caudal lung lobe. The mass was diagnosed as a mucinous cystadenoma. Histochemical and immunohistochemical tests were performed to further characterize the tumour. Surfactant proteins A, B, C and D were not found in the neoplastic cells, suggesting that the tumour arose from a non-surfactant-producing alveolar lining cell. Pulmonary mucinous cystadenomas are uncommon benign tumours in man and have not been reported previously in animals.
Collapse
Affiliation(s)
- C R Michaud
- Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | |
Collapse
|
19
|
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Nakatani Y, Petersen I, Roggli V, Thunnissen E, Tsao M. Diagnosis of lung adenocarcinoma in resected specimens: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2013; 137:685-705. [PMID: 22913371 DOI: 10.5858/arpa.2012-0264-ra] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new lung adenocarcinoma classification has been published by the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society. This new classification is needed to provide uniform terminology and diagnostic criteria, most especially for bronchioloalveolar carcinoma. It was developed by an international core panel of experts representing all 3 societies with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons.This summary focuses on the aspects of this classification that address resection specimens. The terms bronchioloalveolar carcinoma and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced, such as adenocarcinoma in situ and minimally invasive adenocarcinoma for small solitary adenocarcinomas with either pure lepidic growth (adenocarcinoma in situ) and predominant lepidic growth with invasion of 5 mm or less (minimally invasive adenocarcinoma), to define the condition of patients who will have 100% or near 100% disease-specific survival, respectively, if they undergo complete lesion resection. Adenocarcinoma in situ and minimally invasive adenocarcinoma are usually nonmucinous, but rarely may be mucinous. Invasive adenocarcinomas are now classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous bronchioloalveolar carcinoma), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous bronchioloalveolar carcinoma), colloid, fetal, and enteric adenocarcinoma.It is possible that this classification may impact the next revision of the TNM staging classification, with adjustment of the size T factor according to only the invasive component pathologically in adenocarcinomas with lepidic areas.
Collapse
Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Choi YA, Lee HY, Han J, Choi JY, Kim J, Kwon OJ, Lee KS. Pulmonary mucinous cystadenocarcinoma: report a case and review of CT findings. Korean J Radiol 2013; 14:384-8. [PMID: 23483761 PMCID: PMC3590356 DOI: 10.3348/kjr.2013.14.2.384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/28/2012] [Indexed: 12/26/2022] Open
Abstract
A pulmonary mucinous cystadenocarcinoma is an extremely rare tumor that is considered to be a cystic variant of mucin-producing lung adenocarcinoma. We present a case of pulmonary mucinous cystadenocarcinoma in a 54-year-old woman. Chest CT scans showed a 4.3-cm-sized, lobulated, well-defined, and homogeneous mass in the right middle lobe with peripheral stippled calcifications that demonstrated low-attenuation with no enhancement after contrast administration; 18F-fluorodeoxyglucose (FDG) PET/CT demonstrated mild heterogeneous FDG uptake. The mass was diagnosed as adenocarcinoma with mucin production by transbronchial lung biopsy. Right middle lobectomy was performed, and the pathologic examination disclosed a pulmonary mucinous cystadenocarcinoma.
Collapse
Affiliation(s)
- Youn Ah Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | | | | | | | | | | | | |
Collapse
|
21
|
Cabibi D, Sciuto A, Geraci G, Lo Nigro C, Modica G, Cajozzo M. Cystic mucinous adenocarcinoma of the lung: a case report. J Cardiothorac Surg 2011; 6:128. [PMID: 21970610 PMCID: PMC3199241 DOI: 10.1186/1749-8090-6-128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 10/04/2011] [Indexed: 12/22/2022] Open
Abstract
Mucinous cystic tumors of the lung are uncommon, the preoperative pathologic diagnosis is difficult and their biological behavior is still controversial. We report the case of a patient with a clinically benign cystic lesion that post-operatively showed to be consistent with an invasive adenocarcinoma arising in a mucinous cystadenoma of the lung. We underline the difficulty of the clinical pre-operative diagnosis of this cystic neoplasia radiologically mimicking a hydatid cyst, and we report the negative TTF1 immunostaining potentially misleading in the differential diagnosis with metastatic mucinous carcinomas. Finallly, we evidence the presence of a pre-existing mucinous benign lesion suggesting early and complete resection of benign appearing lung cysts because they can undergo malignant transformation if left untreated or they can already harbor foci of invasive carcinoma at the time of the presentation. Even if a good prognosis, better than in other lung carcinomas, with no recurrrence or metastasis after complete surgical exicision, has been reported for cystic mucinous cystoadenocarcinomas, the follow-up showed an aggressive biological behaviour, with the early onset of metastasis, in keeping with P53 positive immunostaining and high Ki-67 proliferation index.
Collapse
Affiliation(s)
- Daniela Cabibi
- Department of Human Pathology, University of Medicine, Policlinico, Via del Vespro 129, 90127 Palermo, Italy.
| | | | | | | | | | | |
Collapse
|
22
|
Morency E, Rodriguez Urrego PA, Szporn AH, Beth Beasley M, Chen H. The "drunken honeycomb" feature of pulmonary mucinous adenocarcinoma: a diagnostic pitfall of bronchial brushing cytology. Diagn Cytopathol 2011; 41:63-6. [PMID: 21563323 DOI: 10.1002/dc.21728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 03/27/2011] [Indexed: 11/06/2022]
Abstract
Pulmonary mucinous adenocarcinoma (PMA) is the terminology recently proposed in the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) International Multidisciplinary Classification of Lung Adenocarcinoma Guidelines for most tumors previously classified as mucinous bronchioloalveolar carcinomas (mBACs). PMA is histologically characterized by lepidic growth and at least some degree of invasive growth of goblet or columnar neoplastic cells with abundant intracytoplasmic mucin. We report here the cytologic features of PMA in a bronchial brushing specimen. The patient is an 84-year-old woman with a persistent dense consolidation in the right middle lobe of the lung found on non-contrast computed tomography (CT) scan. Bronchial brushing smears showed a monotonous population of columnar neoplastic cells forming "drunken honeycomb"-like cell clusters. The neoplastic cells displayed inconspicuous cytologic atypia. The concurrent transbronchial tissue biopsy and the resection specimen confirmed the diagnosis of PMA. Due to the bland nuclear features, the neoplastic cells in the bronchial brushing specimen were interpreted as benign at the time of the initial diagnosis, demonstrating a diagnostic pitfall of bronchial brushing cytology. A high index of suspicion is recommended when a lung lesion with "drunken honeycomb"-like cell clusters is encountered in bronchial brushing specimens. The review of the literature regarding the recently designated PMA is presented.
Collapse
Affiliation(s)
- Elizabeth Morency
- Department of Pathology, Mount Sinai School of Medicine, New York, New York 10029-6574, USA
| | | | | | | | | |
Collapse
|
23
|
Cistoadenocarcinoma gigante mucinoso primario de pulmón: presentación de un caso y revisión de la literatura. Arch Bronconeumol 2011; 47:216-7. [DOI: 10.1016/j.arbres.2010.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 12/01/2010] [Accepted: 12/02/2010] [Indexed: 11/18/2022]
|
24
|
Primary pulmonary mucinous cystadenocarcinoma: a case report. Case Rep Med 2011; 2011:562026. [PMID: 21541179 PMCID: PMC3085439 DOI: 10.1155/2011/562026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/14/2011] [Accepted: 01/28/2011] [Indexed: 12/08/2022] Open
Abstract
Primary pulmonary mucinous cystadenocarcinoma (PMCAC) is an extremely rare cystic neoplasm. A case of a 56-year-old male with a cystic lesion of the right lower lobe is described. Preoperative fine needle aspiration cytology and bronchoscopy were inconclusive. The patient underwent a formal right lower lobectomy and mediastinal lymph node dissection. Diagnosis was established intraoperatively. The biological behavior of primary PMCAC is unknown. Therefore, careful long-term follow-up is considered necessary because of lack of experience globally.
Collapse
|
25
|
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JHM, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6:244-85. [PMID: 21252716 PMCID: PMC4513953 DOI: 10.1097/jto.0b013e318206a221] [Citation(s) in RCA: 3372] [Impact Index Per Article: 259.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. METHODS An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS The classification addresses both resection specimens, and small biopsies and cytology. The terms BAC and mixed subtype adenocarcinoma are no longer used. For resection specimens, new concepts are introduced such as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) for small solitary adenocarcinomas with either pure lepidic growth (AIS) or predominant lepidic growth with ≤ 5 mm invasion (MIA) to define patients who, if they undergo complete resection, will have 100% or near 100% disease-specific survival, respectively. AIS and MIA are usually nonmucinous but rarely may be mucinous. Invasive adenocarcinomas are classified by predominant pattern after using comprehensive histologic subtyping with lepidic (formerly most mixed subtype tumors with nonmucinous BAC), acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype. Variants include invasive mucinous adenocarcinoma (formerly mucinous BAC), colloid, fetal, and enteric adenocarcinoma. This classification provides guidance for small biopsies and cytology specimens, as approximately 70% of lung cancers are diagnosed in such samples. Non-small cell lung carcinomas (NSCLCs), in patients with advanced-stage disease, are to be classified into more specific types such as adenocarcinoma or squamous cell carcinoma, whenever possible for several reasons: (1) adenocarcinoma or NSCLC not otherwise specified should be tested for epidermal growth factor receptor (EGFR) mutations as the presence of these mutations is predictive of responsiveness to EGFR tyrosine kinase inhibitors, (2) adenocarcinoma histology is a strong predictor for improved outcome with pemetrexed therapy compared with squamous cell carcinoma, and (3) potential life-threatening hemorrhage may occur in patients with squamous cell carcinoma who receive bevacizumab. If the tumor cannot be classified based on light microscopy alone, special studies such as immunohistochemistry and/or mucin stains should be applied to classify the tumor further. Use of the term NSCLC not otherwise specified should be minimized. CONCLUSIONS This new classification strategy is based on a multidisciplinary approach to diagnosis of lung adenocarcinoma that incorporates clinical, molecular, radiologic, and surgical issues, but it is primarily based on histology. This classification is intended to support clinical practice, and research investigation and clinical trials. As EGFR mutation is a validated predictive marker for response and progression-free survival with EGFR tyrosine kinase inhibitors in advanced lung adenocarcinoma, we recommend that patients with advanced adenocarcinomas be tested for EGFR mutation. This has implications for strategic management of tissue, particularly for small biopsies and cytology samples, to maximize high-quality tissue available for molecular studies. Potential impact for tumor, node, and metastasis staging include adjustment of the size T factor according to only the invasive component (1) pathologically in invasive tumors with lepidic areas or (2) radiologically by measuring the solid component of part-solid nodules.
Collapse
Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Haruki T, Nakamura H, Taniguchi Y, Miwa K, Adachi Y, Fujioka S. Pulmonary mucinous cystadenoma: a rare benign tumor of the lung. Gen Thorac Cardiovasc Surg 2010; 58:287-90. [DOI: 10.1007/s11748-009-0519-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 07/17/2009] [Indexed: 10/19/2022]
|
27
|
Primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele: a case report. J Med Case Rep 2009; 3:8581. [PMID: 19830231 PMCID: PMC2737758 DOI: 10.4076/1752-1947-3-8581] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 03/31/2009] [Indexed: 11/08/2022] Open
Abstract
Introduction Primary pulmonary mucinous cystadenocarcinoma is a rare variety of lung cancer. It is characterized pathologically by copious mucin production predominantly in the extracellular space. This tumour has a remarkably favorable prognosis. Case presentation We present imaging and histopathological findings of primary pulmonary mucinous cystadenocarcinoma presenting as a complex bronchocele in a 67-year-old Caucasian woman. Conclusion Diagnosis of pulmonary mucinous cystadenocarcinoma should be considered in patients presenting with bronchocele that has suspicious imaging features, because the results of fine needle aspiration cytology and bronchoscopy are frequently inconclusive in these tumours. Positive emission tomography has an important role in helping to identify these tumours.
Collapse
|
28
|
Metaxas G, Tangalos A, Pappa P, Papageorgiou I. Mucinous cystic neoplasms of the mesentery: a case report and review of the literature. World J Surg Oncol 2009; 7:47. [PMID: 19454018 PMCID: PMC2691402 DOI: 10.1186/1477-7819-7-47] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 05/19/2009] [Indexed: 12/13/2022] Open
Abstract
Background Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites. While their pathogenesis remains conjectural, their similarities suggest a common pathway of development. There have been rare reports involving the mesentery as a primary tumour site. Case presentation A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain. At laparotomy, the mass was fixed within the colonic mesentery. Histology demonstrated a benign mucinous cystadenoma. Methods and results We review the literature on mucinous cystic neoplasms of the mesentery and report on the pathogenesis, biologic behavior, diagnosis and treatment of similar extra-ovarian tumors. We propose an updated classification of mesenteric cysts and cystic tumors. Conclusion Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. An updated classification of mesenteric cysts and cystic tumors is proposed.
Collapse
Affiliation(s)
- Georgios Metaxas
- University Hospital of South Manchester, The Nightingale and Genesis Prevention Centre, Southmoor Road, M239LT, Manchester UK.
| | | | | | | |
Collapse
|
29
|
Chhieng DC. Fine-needle aspiration cytology of pulmonary mucinous cystadenocarcinoma. Diagn Cytopathol 2008; 36:581-5. [PMID: 18618726 DOI: 10.1002/dc.20845] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 64-year-old man presented with symptoms of a lung infection. Radiologic work-up revealed opacity in the upper lobe of right lung. A computer tomographic (CT) guided fine-needle aspiration biopsy revealed sheets and clusters of mild to moderately atypical epithelial cells, small amount of mucin, histiocytes, multinucleated giant cells, and stromal fragments. The differential diagnosis included an inflammatory process and a well-differentiated adenocarcinoma. A lobectomy was performed and revealed abundant extracellular mucin surrounded partially by a thick fibrous wall, which was lined by neoplastic glandular cells. The histology was consistent with a pulmonary mucinous cystadenocarcinoma. Fibroblastic proliferation and foreign-body giant reaction secondary to extravasation of mucin were also noted. The patient was disease free 1 year after initial diagnosis. The relative lack of mucin as well as the presence of well-differentiated neoplastic cells, the inflammatory response to extravasated mcuin constitutes a potential pitfall in recognizing pulmonary mucinous cystadenocarcinoma cytologically.
Collapse
Affiliation(s)
- David C Chhieng
- Department of Pathology, University of Alabama, Birmingham, Alabama 35249-6823, USA.
| |
Collapse
|
30
|
Wynveen C, Behmaram B, Haasler G, Rao N. Diverse histologic appearances in pulmonary mucinous cystic neoplasia: a case report. J Med Case Rep 2008; 2:312. [PMID: 18823534 PMCID: PMC2564958 DOI: 10.1186/1752-1947-2-312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 09/29/2008] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Primary pulmonary mucinous cystic neoplasia comprises a group of tumors, from benign cystadenoma to mucinous cystadenocarcinoma. CASE PRESENTATION We report a case of primary pulmonary mucinous cystadenocarcinoma in a 75-year-old woman who was found to have a right hilar mass on a routine chest X-ray. A lobectomy was performed and the resection specimen revealed a multicystic mucinous tumor. Microscopically, the tumor was composed of confluent mucin-filled cystic spaces lined by columnar mucin-secreting cells which ranged from cytologically bland to moderately atypical with 'bronchioloalveolar pattern' invasion into the adjacent parenchyma. Immunohistochemically, tumor cells were positive diffusely for Cytokeratin 7, and focally for Cytokeratin 20 and Thyroid Transcription Factor-1. CONCLUSION This case highlights the continuous spectrum of pulmonary mucinous cystic neoplasia from benign mucinous cystadenoma to malignant mucinous cystadenocarcinoma, and the probable existence of a 'borderline' mucinous cystic tumor. Although molecular data are lacking to substantiate progression from benign to malignant in these neoplasms, the importance of recognizing the morphologic continuum lies in alerting pathologists to thoroughly examine specimens to rule out invasive foci in tumors with 'borderline' morphology.
Collapse
Affiliation(s)
- Christine Wynveen
- Departments of Pathology Medical College of Wisconsin, Milwaukee, WI, USA.
| | | | | | | |
Collapse
|
31
|
Borczuk AC. Benign Tumors and Tumorlike Conditions of the Lung. Arch Pathol Lab Med 2008; 132:1133-48. [DOI: 10.5858/2008-132-1133-btatco] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Benign tumors and tumorlike conditions of the lung are encountered in the pathologic evaluation of asymptomatic and symptomatic lung nodules. Since many of these lesions are uncommon, they can be diagnostically challenging.
Objective.—To review the current classification of benign lung tumors, with emphasis on histopathology and useful ancillary studies.
Data Sources.—The current World Health Organization classification system for lung neoplasms and review of relevant publications.
Conclusions.—Despite improved imaging techniques, benign lung nodules are encountered in wedge biopsy and resection specimens. Histopathology, immunohistochemistry, and molecular techniques ensure accurate pathologic diagnosis and have shed light on the histogenesis of these unusual lesions.
Collapse
Affiliation(s)
- Alain C. Borczuk
- From the Department of Surgical Pathology, Columbia University Medical Center, New York, NY
| |
Collapse
|
32
|
Iwasaki T, Kawahara K, Nagano T, Nakagawa K. Pulmonary mucinous cystadenocarcinoma: an extremely rare tumor presenting as a cystic lesion of the lung. Gen Thorac Cardiovasc Surg 2007; 55:143-6. [PMID: 17447515 DOI: 10.1007/s11748-006-0089-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pulmonary mucinous cystadenocarcinoma (PMC) is a rare tumor characterized by mucin production. It is similar to tumors of the same name arising in the ovaries and pancreas. Here we describe the 20th case of PMC reported in the English literature. The patient was a 75-year-old woman with a 3-day history of bloody sputum. Chest radiography and computed tomography revealed a cavitary mass 5 cm in diameter in the posterior segment of the right lung. 18F-fluorodeoxyglucose positron emission tomography demonstrated intense uptake in the wall of the lesion. Right lower lobectomy was performed, and the pathology examination revealed this tumor to be a PMC. The preoperative serum CA 19-9 level was 162.3 U/ml (cutoff 37 U/ml) and decreased to 22.8 U/ml after resection. No mutation of epidermal growth factor receptor or K-ras gene was detected. Thoracic surgeons should bear in mind this rare tumor for the differential diagnosis of a pulmonary cystic lesion.
Collapse
Affiliation(s)
- Teruo Iwasaki
- Department of Respiratory Surgery, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Osaka, Japan.
| | | | | | | |
Collapse
|