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Liu H, Huang P, Zhang M, Zhu X, Chen J, Xiao M. Ciliated muconodular papillary tumor of the lung: a case report and literature review. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-021-00094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Ciliated Muconodular Papillary Tumor (CMPT) was first reported in 2002, and fewer than 100 cases have since been reported. The prognosis after surgical resection is good, and recurrence has not been reported. However, it is easily misdiagnosed as adenocarcinoma. Summarizing the CT features of CMPT will help doctors better understand the disease.
Case presentation
Here, we report a rare and interesting case of ciliated muconodular papillary tumor. A 6-mm diameter solid nodule with slight lobulation, short spines, and subpleural indentation. Patients with clinical diagnosis of high-risk subpleural nodule in the left lung underwent thoracoscopic surgery. Most CMPT cases lack specific clinical manifestations and were found incidentally on physical examination or during a workup for other diseases. The disease was diagnosed through CT and biopsy, and it responded well to surgery.
Conclusions
This paper presents the detailed computed tomography features of CMPT to help prevent misdiagnosis. The typical manifestations of CMPT imaging as solid and partial nodules, nodules in subpleural or peripheral zones, and nodules contain cavities.
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Takeda-Miyata N, Miyagawa-Hayashino A, Hamada S, Nagamine M, Fujii T, Imura T, Tsunezuka H, Shimomura M, Yamaguchi T, Yanada M, Inoue M, Konishi E. A clinicopathologic and molecular analysis of five cases of bronchiolar adenoma with rare mutations. Pathol Int 2022; 72:273-282. [PMID: 35234319 DOI: 10.1111/pin.13213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
Abstract
Bronchiolar adenoma (BA) is a rare benign lung tumor that shows proliferation of bland bronchiolar-type epithelium containing a continuous layer of basal cells. This tumor entity has been newly added to the recent World Health Organization (WHO) classification 5th edition. This entity encompasses a spectrum of lesions: the classic ciliated muconodular papillary tumor (CMPT) and the non-classic CMPT. Although BA is reported to have driver mutations including BRAF V600E, EGFR, and KRAS, the molecular profile of BA is still incompletely understood. Five resected BAs at our institutions were analyzed. The BA lesions were subdivided into two groups: three proximal-type BAs and two distal-type BAs. NRAS codon 12/13 mutation and EML4 exon 20-ALK exon 20 fusion were found in two of the three proximal-types. BRAF V600E mutation was found in one of the two distal-types. Two cases coexisted with lung adenocarcinoma, with EGFR exon 19 deletion and KRAS mutation, respectively. No recurrence was observed at a median of 12 months (range 2-84 months) of follow-up. BA has uncommon variants of mutation seen in lung adenocarcinoma. NRAS mutation and ALK fusion partner has not been reported previously. The present cases may reinforce the distinctive biology of BA from lung adenocarcinoma.
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Affiliation(s)
- Naoko Takeda-Miyata
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Aya Miyagawa-Hayashino
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Michiko Nagamine
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Tetsuya Imura
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Tsunezuka
- Department of Surgery, Division of Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Shimomura
- Department of Surgery, Division of Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Masashi Yanada
- Department of Thoracic Surgery, Otsu City Hospital, Shiga, Japan
| | - Masayoshi Inoue
- Department of Surgery, Division of Thoracic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Layfield LJ, Baloch Z. Atypia in pulmonary cytology: Morphologic spectrum and causes. Diagn Cytopathol 2021; 50:164-171. [PMID: 34800334 DOI: 10.1002/dc.24902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The term "atypical" has had a long history of usage in cytology but has had variable definitions and usage. Most commonly the term was used to indicate a degree of cytomorphologic abnormality greater than that clearly due to reactive or reparative changes but not associated with a high concern on the part of the cytopathologist that a malignancy is present. The Papanicolaou Society of Cytopathology System for Reporting Respiratory Cytology provided a foundation for using the category "Atypical" along with the category "Suspicious for Malignancy" to categorize the spectrum of morphologic changes ranging from those which are clearly benign to those that are clearly malignant. The two intermediate categories of "Atypical" and "Suspicious for Malignancy" have characteristic recommendations resulting in clinical utility for both categories. CONCLUSION The Papanicolaou Society of Cytopathology System for Reporting Respiratory Cytology represents a useful system with defined intermediate categories of Atypical and Suspicious for Malignancy.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Plaksin SA. [Diagnosis and treatment of benign lung tumors]. Khirurgiia (Mosk) 2021:106-111. [PMID: 34029044 DOI: 10.17116/hirurgia2021061106] [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: 11/18/2022]
Abstract
Benign lung tumors account 2-12% of all lung neoplasms. The classification of lung tumors, adopted by the World Health Organization in 2015, is reported with a detailed indication of all changes based on immunohistochemical and genetic studies. Diagnosis with computed tomography, dynamic and perfusion computed tomography, virtual bronchoscopy and positron emission tomography is described. These methods ensure 94-98% sensitivity for differentiation with malignancies. CT and ultrasound signs of benign tumors are presented. Surgical strategy for newly diagnosed nodes in the lungs is analyzed depending on their dimensions and risk factors. It was shown that comprehensive examination with possible surgical verification of the diagnosis is necessary for nodes over 6 mm and moderate-to-high risk factors. The authors describe argon plasma and laser destruction, bronchoplastic procedures for central benign tumors, thoracoscopy for peripheral neoplasms. One can conclude that high-tech methods of radiological and nuclear diagnosis are valuable to determine benign neoplasms and their dimensions with a high degree of reliability. Endoscopic and thoracoscopic procedures are successfully used for benign tumors.
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Affiliation(s)
- S A Plaksin
- Vagner Perm State Medical University, Perm, Russia
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Shirsat H, Zhou F, Chang JC, Rekhtman N, Saqi A, Argyropoulos K, Azour L, Simms A, Melamed J, Hung YP, Roden AC, Mino-Kenudson M, Moreira AL, Narula N. Bronchiolar Adenoma/Pulmonary Ciliated Muconodular Papillary Tumor. Am J Clin Pathol 2021; 155:832-844. [PMID: 33313677 DOI: 10.1093/ajcp/aqaa194] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To describe the histologic features that are helpful in the diagnosis of the rare bronchiolar adenomas/ciliated muconodular papillary tumors (BAs/CMPTs) during intraoperative consultation. METHODS Multi-institutional retrospective review of frozen sections of 18 BAs/CMPTs. RESULTS In 14 of 18 cases, BA/CMPT was the primary reason for sublobar lung resection, and in 4 cases, BA/CMPT was an incidental finding intraoperatively for resections performed for carcinoma in other lobes. There were 11 proximal-type/classic BAs/CMPTs and 7 distal-type/nonclassic BAs/CMPTs. Only 3 (16.7%) of 18 were correctly diagnosed at the time of frozen section, all of which were proximal type/classic. The remainder were diagnosed as adenocarcinoma (n = 7); invasive mucinous adenocarcinoma (n = 1); non-small cell lung carcinoma (n = 1); cystic mucinous neoplasm, favor adenocarcinoma (either mucinous or colloid type) (n = 1); favor adenocarcinoma, cannot exclude CMPT (n = 1); atypical proliferation (n = 2); mucinous epithelial proliferation (n = 1); and mucous gland adenoma (n = 1). CONCLUSIONS BA/CMPT can potentially be misdiagnosed as carcinoma during intraoperative consultation. On retrospective review of the frozen sections, the presence of the following may help to avoid misdiagnosis: a mixture of bland ciliated columnar cells, mucinous cells, and, most important, a basal cell layer, as well as a lack of necrosis, significant atypia, and mitoses.
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Affiliation(s)
| | | | - Jason C Chang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anjali Saqi
- Department of Pathology, Columbia University Medical Center, New York, NY
| | | | - Lea Azour
- Radiology, NYU Langone Health, New York, NY
| | | | | | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic School of Medicine, Rochester, MN
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Yang C, Wang X, Da J, Ma K. Distal-type bronchiolar adenoma of the lung harboring an EGFR exon 21 p.L858R mutation: A case report. Thorac Cancer 2020; 11:3596-3598. [PMID: 33063939 PMCID: PMC7705926 DOI: 10.1111/1759-7714.13692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022] Open
Abstract
Here, we present a case of a distal‐type bronchiolar adenoma (BA) of the lung. BAs are benign lung tumors characterized by nodular proliferation of bilayered bronchiolar‐type epithelium with a continuous layer of basal cells. This patient underwent S3 segmentectomy following detection by computed tomography (CT) scan of a gradually enlarging ground‐glass nodule (GGO) over a five month period. Nodule morphology and immunophenotype were consistent with those of distal‐type BA of the lung. An epidermal growth factor receptor (EGFR) exon 21 p.L858R missense mutation was identified which, to the best of our knowledge, is the first case to be reported of a common gene mutation associated with non‐small cell lung cancer (NSCLC) being found in a BA lesion. Following surgery, the patient remains relapse‐free. Key points Significant findings of the study Pathological assessment of a lung nodule confirmed a papillary tumor with a double‐layered cell structure, less than typical cytoplasm, and a mixture of ciliated columnar and globular cells, consistent with a distal‐type bronchiolar adenoma.
What this study adds This is the first report of an EGFR exon 21 p.L858R mutation in a bronchiolar adenoma.
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Affiliation(s)
- Chenglin Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiaoliang Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Jiping Da
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Kai Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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Tachibana M, Saito M, Kobayashi J, Isono T, Yatabe Y, Tsutsumi Y. Distal-type bronchiolar adenoma of the lung expressing p16 INK4a - morphologic, immunohistochemical, ultrastructural and genomic analysis - report of a case and review of the literature. Pathol Int 2020; 70:179-185. [PMID: 32030846 PMCID: PMC7079048 DOI: 10.1111/pin.12904] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Abstract
Bronchiolar adenoma (BA) of the lung is a rare benign neoplasm. Because of a chest abnormal shadow indicated by health checkup, a 77-year-old female nonsmoker underwent computed tomography, revealing an 8 mm ground glass nodule in the peripheral field of the right lower lobe. Wedge resection of the nodule was performed, with a frozen diagnosis of primary lung adenocarcinoma. The localized, 8 × 4 × 3 mm-sized, jelly-like mass microscopically revealed a lepidic-growing lesion composed of ciliated columnar cells, mucous cells and basal cells surrounded by mucin pool. Neither nuclear atypia nor mitotic activity was noted. Immunohistochemically, the ciliated, mucous and basal cells were positive for TTF-1 and p16INK4a . Mucous cells were positive for napsin A and focally expressed MUC5AC. MUC6 was negative. Basal cells were positive for CK5/6, p40, p63 and podoplanin. Human papillomavirus genome was undetectable by in situ hybridization. Ultrastructurally, the bronchiolar epithelial tubules consisted of two layers, the inner nonciliated microvillous cells and the outer basal-like cells, and some of the inner cells were filled with mucin granules in cytoplasm. Molecular analysis of the tumor failed to show driver mutations. The final diagnosis was distal-type BA. The postoperative course was uneventful for 6 months.
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Affiliation(s)
- Mitsuhiro Tachibana
- Department of Diagnostic Pathology, Shimada Municipal Hospital, Shizuoka, Japan
| | - Masao Saito
- Department of Thoracic Surgery, Shimada Municipal Hospital, Shizuoka, Japan
| | - Jun Kobayashi
- Department of Thoracic Surgery, Shimada Municipal Hospital, Shizuoka, Japan
| | - Tadahiro Isono
- Department of Surgery, Shimada Municipal Hospital, Shizuoka, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Tsutsumi
- Department of Diagnostic Pathology, Shimada Municipal Hospital, Shizuoka, Japan.,Diagnostic Pathology Clinic, Pathos Tsutsumi, Aichi, Japan
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Shen L, Lin J, Ren Z, Wang B, Zhao K, Lu Y, Wang F, Zhan L. Ciliated muconodular papillary tumor of the lung: report of two cases and review of the literature. J Surg Case Rep 2019; 2019:rjz247. [PMID: 31528329 PMCID: PMC6736349 DOI: 10.1093/jscr/rjz247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/05/2019] [Indexed: 12/14/2022] Open
Abstract
Ciliated muconodular papillary tumor (CMPT) is a peripheral non-endobronchial lung nodule, consisting of ciliated columnar cells and goblet cells with basaloid cell proliferation. Only about 50 cases confirmed by surgery have been reported in English literature worldwide. We present two surgical cases of CMPT in this report. Two patients presented with abnormal computed tomography findings but no obvious symptoms. The first patient's intraoperative frozen examination was unable to distinguish benignity from malignancy, and he received lobectomy. The other patient's intraoperative frozen examination indicated adenocarcinoma, but she received wedge resection for her refusal to lobectomy. The two patients' postoperative pathological analysis finally confirmed the diagnosis of CMPT. We believe that our cases may be essential for pathologists and surgeons to improve their understanding.
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Affiliation(s)
- Leilei Shen
- Department of Thoracic Surgery, Branch of PLA General Hospital, Sanya, Hainan, China
| | - Jixing Lin
- Department of Thoracic Surgery, Branch of PLA General Hospital, Sanya, Hainan, China
| | - Zhipeng Ren
- Department of Thoracic Surgery, Branch of PLA General Hospital, Sanya, Hainan, China
| | - Bailin Wang
- Department of Thoracic Surgery, Branch of PLA General Hospital, Sanya, Hainan, China
| | - Kai Zhao
- Department of Thoracic Surgery, Branch of PLA General Hospital, Sanya, Hainan, China
| | - Yunlong Lu
- Department of Pathology, Branch of PLA General Hospital, Sanya, Hainan, China
| | - Fulin Wang
- Department of Pathology, Branch of PLA General Hospital, Sanya, Hainan, China
| | - Lianbin Zhan
- Department of Thoracic Surgery, Branch of PLA General Hospital, Sanya, Hainan, China
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