Mucoepidermoid lung tumors

Pulmonary Cytopathology: Current and Future Impact of Microscopy and Immunohistochemistry

With the advancement of tissue procurement techniques, in-depth knowledge of morphology is crucial for cytopathologists to diagnose neoplastic and nonneoplastic lung diseases optimally. Cytopathologists must also be well versed in immunohistochemistry/immunocytochemistry markers and their interpretation for an accurate diagnosis.

White out hemithorax secondary to salivary gland type of lung cancer with metastasis in liver and bone: a case report

BACKGROUND

Salivary gland-type lung carcinomas are uncommon neoplasms of the lung, representing less than 1% of all lung tumors. The two most common among them are adenoid cystic carcinoma and mucoepidermoid carcinoma. Although they usually have an indolent behavior, adenoid cystic carcinomas can be more aggressive, with 5-year survival as low as 55%. Very few cases are reported in literature. We report a similar rare case of salivary gland type lung carcinoma that presented for the first time with unilateral opacification of left hemithorax.

CASE PRESENTATION

A 38-year-old man of North Indian origin, who was a a nonsmoker, presented with complaints of shortness of breath and cough for 1 year, which has increased in the last 2 months and was associated with significant weight loss. A frontal radiograph of the chest and computed tomography of the chest were performed, which showed a mass in the left upper lobe of the lung with its epicenter in the left main bronchus. A bronchoscopic guided biopsy was performed, and histopathology confirmed the diagnosis of lung carcinoma of salivary gland type (adenoid cystic carcinoma). There was invasion of major vessels, hence the patient was offered and started on palliative management instead of surgical treatment. In spite of palliative management of two cycles of chemotherapy and radiotherapy, the patient succumbed to the disease within 2 months from the time of diagnosis.

CONCLUSION

Lung carcinoma of the salivary gland type (especially adenoid cystic carcinoma) usually presents at a later stage. The resectability of the tumor depends on the involvement of the surrounding major vessels. Interestingly, these cancers have no association with smoking. The prognosis depends on the extent of the disease at the time of diagnosis. Hence, imaging plays a major role in deciding the further plan of management.

Outcome of Primary Lung Salivary Gland-Type Carcinoma: A Population-Based Study

Introduction. Primary pulmonary salivary gland-type carcinomas are rare malignancies arising from minor salivary gland tissue in the lower respiratory tract. Given their rarity, constituting <1% of all primary lung malignancies, their epidemiological features and outcomes remain poorly documented. This study analyzed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database to identify primary pulmonary salivary gland carcinomas, including the most prevalent tumor types. Methods. All patients diagnosed with mucoepidermoid carcinoma, adenoid cystic carcinoma, and epithelial-myoepithelial carcinoma, with the lung designated as the primary site between 1975 and 2019, were subject to analysis. Overall and disease-specific survival were calculated using Kaplan-Meier curves and Cox proportional hazards models. Results. The study identified 323 mucoepidermoid carcinoma, 284 adenoid cystic carcinoma, and 6 epithelial-myoepithelial carcinoma diagnosed as pulmonary salivary gland-type carcinoma. An analysis of age distribution revealed a unimodal pattern for both mucoepidermoid carcinoma and adenoid cystic carcinoma, with most patients diagnosed after age 40. Most patients were Caucasians (77% for mucoepidermoid carcinoma and 83% for adenoid cystic carcinoma). Both disease-specific and overall survival were worse for patients diagnosed at the age of 60 years or above. Race or sex did not significantly impact patient survival. High-grade mucoepidermoid carcinoma demonstrated a significantly worse prognosis than low or intermediate-grade mucoepidermoid carcinoma. Conclusion. A comprehensive review of clinical and epidemiological features of pulmonary salivary gland-type carcinomas reveals that the age of diagnosis and tumor grade are the most significant factors in determining patient survival.

Evolving Diagnostic Approach of Pulmonary Salivary Gland-type Tumors

Pulmonary salivary gland-type, although bear resemblance to their salivary gland counterparts, present a diagnostic challenge due to their rarity. Clinical features overlap with lung carcinoma; however, management strategies and outcomes are distinct. Onus falls on the pathologist to avoid misinterpretation of small biopsies especially in young, nonsmokers with slow growing or circumscribed endobronchial growths. A combination of cytokeratin, myoepithelial immunohistochemical markers, and identification of signature molecular alteration is invaluable in differentiation from lung cancers and subtyping the pulmonary salivary gland-type tumor.

Current diagnosis and treatment of salivary gland-type tumors of the lung

Salivary gland-type tumors of the lung are thought to originate from the submucosal exocrine glands of the large airways. Due to their rare occurrence, reports of their study are limited to small-scale or case reports. Therefore, daily clinical practices often require a search for previous reports. In the last 20 years, several genetic rearrangements have been identified, such as MYB::NF1B rearrangements in adenoid cystic carcinoma, CRTC1::MAML2 rearrangements in mucoepidermoid carcinoma, EWSR1::ATF1 rearrangements in hyalinizing clear cell carcinoma and rearrangements of the EWSR1 locus or FUS (TLS) locus in myoepithelioma and myoepithelial carcinoma. These molecular alterations have been useful in diagnosing these tumors, although they have not yet been linked to molecularly targeted therapies. The morphologic, immunophenotypic, and molecular characteristics of these tumors are similar to those of their counterparts of extrapulmonary origin, so clinical and radiologic differential diagnosis is required to distinguish between primary and metastatic disease of other primary sites. However, these molecular alterations can be useful in differentiating them from other primary lung cancer histologic types. The management of these tumors requires broad knowledge of the latest diagnostics, surgery, radiotherapy, bronchoscopic interventions, chemotherapy, immunotherapy as well as therapeutic agents in development, including molecularly targeted agents. This review provides a comprehensive overview of the current diagnosis and treatment of pulmonary salivary gland tumors, with a focus on adenoid cystic carcinoma and mucoepidermoid carcinoma, which are the two most common subtypes.

SALTT study: A retrospective analysis of 111 SAlivary gland tumors of Lung and Tracheobronchial Tree

INTRODUCTION

Primary pulmonary salivary gland-type tumours (PPSGT) are rare lung neoplasms arising from submucosal seromucinous glands in the central airway.

METHODS AND RESULTS

We retrospectively analysed the clinicopathological features of 111 PPSGTs diagnosed at our institute between 2003 and 2021. The mean age at diagnosis was 43.8 years(range 6-78 years) and a male-to-female ratio of 2:1. On imaging, 92 % of cases had centrally located tumours and 37.3 % were early stage. The histopathological types included 70 cases (63 %) of mucoepidermoid carcinoma (MEC), 31 cases (27.7 %) of adenoid cystic carcinoma (ADCC), two cases of myoepithelial carcinoma, one case each of acinic cell carcinoma (ACC), clear cell carcinoma (CCC), epithelial myoepithelial carcinoma (EMC) and 5 others [including adenocarcinoma of minor salivary gland origin(n = 3), carcinoma with sebaceous differentiation(n = 1) and poorly differentiated carcinoma of salivary gland type(n = 1)]. The size of the tumours found in the resection specimens ranged from 1 cm to 13 cm, with an average size of 4.9 cm. High-risk attributes such as lymphovascular invasion (LVI), perineural invasion (PNI), pleural involvement, positive resection margins, and nodal metastasis were identified in 15.3 %, 15.3 %, 13.6 %,15.2 % and 6.7 % of cases, respectively. These attributes were found to be more frequent in ADCC than in MEC. Surgery was the main treatment modality [68/84 (80 %) cases]. ADCC cases had more recurrence and distant metastasis than MEC cases. The 3- year overall-survival (OS) and recurrence-free survival(RFS) were better in patients with age lesser than 60 years(p-value <0.0001), low pT stage (p-value 0.00038) and lower grade of MEC(p-value-0.0067).

CONCLUSION

It is crucial to have an acquaintance with the morphologic spectrum and immunophenotypic characteristics of PPSGT to recognize them in this unusual location. In tandem, it is crucial to differentiate them from conventional primary non-small cell lung carcinoma, as the management protocols and prognostic implications differ significantly.

Rare but clinically important salivary gland-type tumor of the lung: A review

Salivary gland-type tumor (SGT) of the lung, which arises from the bronchial glands of the tracheobronchial tree, was first recognized in the 1950s. SGT represents less than 1% of all lung tumors and is generally reported to have a good prognosis. Mucoepidermoid carcinoma (MEC) and adenoid cystic carcinoma (ACC) are the two most common subtypes, comprising more than 90% of all SGTs. The reported 5-year survival rate of patients with SGT is 63.4%. Because this type of tumor develops in major bronchi, patients with SGT commonly present with symptoms of bronchial obstruction, including dyspnea, shortness of breath, wheezing, and coughing; thus, the tumor is usually identified at an early stage. Most patients are treated by lobectomy and pneumonectomy, but bronchoplasty or tracheoplasty is often needed to preserve respiratory function. Lymphadenectomy in the surgical resection of SGT is recommended, given that clinical benefit from lymphadenectomy has been reported in patients with MEC. For advanced tumors, appropriate therapy should be considered according to the subtype because of the varying clinicopathologic features. MEC, but not ACC, is less likely to be treated with radiation therapy because of its low response rate. Although previous researchers have learned much from studying SGT over the years, the diagnosis and treatment of SGT remains a complex and challenging problem for thoracic surgeons. In this article, we review the diagnosis, prognosis, and treatment (surgery, chemotherapy, and radiotherapy) of SGT, mainly focusing on MEC and ACC. We also summarize reports of adjuvant and definitive radiation therapy for ACC in the literature.

Role of radiotherapy in the management of rare solid thoracic tumors of the adults

Thoracic tumors include more than one hundred histopathological subtypes. Rare thoracic malignancies can be defined as representing less than 1% of all thoracic tumors. The European Rare Cancer Surveillance Project (RARECARE) identified rarity as an incidence less than 6 for 100,000 people, with significant difference of prevalence between them. Modalities of treatment for these pathologies include surgery, radiotherapy, and systemic therapies. In this article, we aim to discuss role and techniques of radiotherapy in management of rare solid thoracic tumors in adults, focusing on different anatomical locations such as lung parenchyma, mediastinum, vessels, chest wall and pleural cavity.

Mucoepidermoid carcinoma cured by a combination of high-frequency snare and photodynamic therapy: A case report

Mucoepidermoid carcinoma (MEC) is a rare salivary gland tumor, accounting for 0.2% of all lung tumors. The standard treatment for MEC of the primary bronchus is surgery, although intraluminal bronchoscopic treatment has recently become an option. A 68-year-old man presented with an asymptomatic bronchial tumor in the right intermediate bronchus. The tumor was resected using a high-frequency snare (HFS) during bronchoscopy, and the specimen was pathologically diagnosed as low-grade MEC. A residual lesion was detected in the resected area by autofluorescence imaging. The tumor appeared to be localized within the subepithelial layer without metastases, and photodynamic therapy (PDT) was performed as a local treatment. The patient had no recurrence for 18 months. PDT is effective and safe for patients with centrally located early-stage lung cancer, but there are few reports of its use for rare tumors, such as MEC. In this case, PDT allowed for local control and avoided surgery, including bronchoplasty, for MEC. Combined treatment of tumor reduction by HFS and PDT of the residual lesion may be an optimal treatment for MEC of the bronchus.

Mucoepidermoid carcinoma of the trachea in a 9-year-old male child: case report and review of literature

Mucoepidermoid carcinoma (MEC) is the most common malignancy of minor salivary glands in adults. Pulmonary MEC is extremely uncommon, comprising only 0.1–0.2% of the primary lung malignancies and <1% of primary bronchial tumors. It is even rarer in children, and literature is limited to a few case reports only. Here we present a case report of a 9-year-old boy diagnosed with primary MEC of the trachea along with a review of the literature. A 9-year-old male child presented with complaint of dry cough for two years which was later associated with shortness of breath after one year. Bronchoscopic examination revealed a growth arising from right lateral wall of carina occluding 50% of the lumen and detailed histopathological examination revealed it to be a MEC of the trachea. The patient underwent local excision of the tumor with primary anastomosis. Because of positive margin, adjuvant radiotherapy of 60 Gy in 30 fractions was given to the tumor bed. The patient tolerated the treatment well and is disease free at 6 months follow-up. Experience with MEC of the trachea in children is limited, and optimal treatment protocols have not been defined, with current treatment mainly extrapolated from MEC of the salivary glands.

The Clinical and Prognostic Characteristics of Primary Salivary Gland-Type Carcinoma in the Lung: A Population-Based Study

This study aimed to explore the clinical and prognostic characteristics of primary salivary gland-type carcinoma (SGC). The entire cohort from the Surveillance, Epidemiology, and End Results database was used to calculate the SGC proportion. In total, 253,096 eligible patients, including 165,715 adenocarcinomas (ADCs), 87,062 squamous cell carcinomas (SCCs), and 319 SGCs, were selected to perform survival analyses. The data of 42 SGC patients from our hospital showed postoperative survival. Overall survival (OS) curves for different histological and surgical types were presented. The proportion of primary SGCs was 0.8 per 1000 patients. Patients with age ≤ 64 years old had a much higher proportion of SGC than those patients with age >64 years old. After adjusting for other confounders, among ADCs, SCCs, and SGC, SGCs had the best prognosis (HR 0.361, p < 0.001). Moreover, the 5-year OS rates of SGC patients were 55% and 7% in the group with surgery or without surgery, respectively (p < 0.001). The data of 42 patients from our hospital also showed a good survival of SGCs. Lobectomy improved the survival of SGCs significantly (adjusted HR 0.439, p = 0.016). In conclusion, pulmonary SGCs had the best prognosis among ADCs, SCCs, and SGCs. In addition, lobectomy could further improve the prognostic outcomes of SGCs.

Pulmonary mucoepidermoid carcinoma in the Chinese population: A clinical characteristic and prognostic analysis

Background

Mucoepidermoid carcinoma is dominant in salivary glands and rarely occurs in the lung. Primary pulmonary mucoepidermoid carcinoma is a type of non-small-cell lung cancer, but the prognostic factors in Chinese patients remain controversial. This investigation aimed to review cases of pulmonary mucoepidermoid carcinoma, analyse the prognosis of this disease.

Methods

Patients with pathologically proven pulmonary mucoepidermoid carcinoma were screened at the Department of Respiratory and Critical Care Medicine at the Peking University Third Hospital, Beijing Friendship Hospital Affiliated to Capital Medical University, and Peking University Cancer Hospital for inclusion in this retrospective study. Demographic data, including age, sex, clinical symptoms, smoking, alcohol consumption, allergies, family history, imaging findings, fibrobronchoscopy findings, surgical procedures, tumour location and pathologic stage, were collected. Telephone follow-up was conducted for all patients not lost to follow-up. The associations of sex, age, smoking, tumour differentiation, tumour size, lymph node metastasis, pathologic stage, and patient survival were retrospectively analysed. Kaplan-Meier, univariate and multivariate analysis curves were used to analyse patient prognosis and prognostic factors.

Results

Thirty-one patients, comprising 23 males and 8 females, were enrolled in the analysis. The mean age was 60.77 ± 11.44 years. The first symptom was nonspecific, with cough being the most common (21/31, 67.77%); smokers accounted for 16 of the 31 patients, and ten patients had a history of alcohol consumption. Overall, the tumours could occur in either lobe of the lungs; tumours occurred in the right lung in 19/31 patients, and tumours occurred in the left lung in 12/31 patients. Regarding TNM stage, 10 patients had stage I (5 with stage 1a, 5 with stage 1b), 5 had stage II (1 with stage 2a, 4 with stage 2b), 3 had stage III (1 with stage 3a, 2 with stage 3b), and 13 had stage IV (10 with stage 4a, 3 with stage 4b). In our Cox univariate survival analysis of patients with pulmonary mucoepidermoid carcinoma, we found that TNM stage IV, degree of differentiation and lymph node metastasis were risk factors for pulmonary mucoepidermoid carcinoma and that degree of differentiation was an independent risk factor.

Conclusion

The clinical, radiographical and pathological features of pulmonary mucoepidermoid carcinoma were systemically analysed and summarized, and the degree of differentiation and lymph node metastasis, as well as prognostic factors in addition to clinical stage, were confirmed.

Salivary Gland-type Tumors of the Lung

CONTEXT.—

Salivary gland-type tumors (SGTs) of the lung represent a distinct group of lung neoplasms. Pulmonary SGTs often pose diagnostic challenges, especially in small biopsy and cytology samples because of limited sample volume and overlapping morphology among pulmonary SGTs, metastatic SGTs of head and neck origin, and other lung tumors.

OBJECTIVE.—

To identify the clinical characteristics, histomorphology, immunophenotypic features, and molecular alterations that are crucial for the diagnosis and differential diagnosis of pulmonary SGTs, especially in small biopsy and cytology specimens.

DATA SOURCES.—

Literature review and authors' personal practice experience.

CONCLUSIONS.—

An accurate diagnosis of pulmonary SGTs can be achieved by careful evaluation of clinical findings and histomorphology in conjunction with immunohistochemical studies and molecular analysis.

Rapid metastasis of stage IA primary pulmonary high-grade mucoepidermoid carcinoma with a cystic airspace: a case report and reflection

Primary pulmonary high-grade mucoepidermoid carcinoma (MEC) with a cystic airspace is uncommon, and early metastasis is extremely rare. In such cases, however, it is clinically important for clinicians to consider whether the tumor has spread to the lymph nodes through the cystic airspace. A 77-year-old man presented to our hospital with cough and hemoptysis. Chest computed tomography showed a 25-mm-diameter mass with a cystic airspace located in the upper lobe of the left lung. The possibility of malignancy was considered. Without a definitive preoperative diagnosis, left upper lobectomy and mediastinal lymphadenectomy were performed. Histopathological examination revealed the typical histological characteristics of high-grade MEC (stage IA) and no lymph node metastasis. However, lymph node metastasis was found 6 months after surgical resection, and radiochemotherapy was performed. The patient developed widespread metastatic disease 4 months following completion of radiochemotherapy and died 2 months later. Primary pulmonary MEC with a cystic airspace is a rare malignant disease with uncommon imaging findings. Complete surgical resection is the main treatment method for high-grade MEC. In this case, we hypothesize that early metastasis was caused by seeding of tumor cells through the cystic airspace.

Clinical Characteristics and Prognosis of Patients With Pulmonary Mucoepidermoid Carcinoma: A SEER-Based Analysis

Background

Primary pulmonary mucoepidermoid carcinoma (PMEC) is an extremely rare malignancy. Its clinical characteristics and prognosis are not fully understood. This study evaluated clinical characteristics and prognostic factors of PMEC and established a nomogram to predict its 1-, 3-, 5- and 10-year cancer-specific survival (CSS) rates.

Methods

In the Surveillance, Epidemiology, and End Results database from January 1, 2016 to December 31, 2016, patients pathologically diagnosed with PMEC were identified. Kaplan-Meier analysis and Cox regression were performed to evaluate the CSS stratified by different covariates. A predictive nomogram model was built and validated by the concordance index (C-index) and calibration curves.

Results

A total of 585 PMEC patients were identified. A total of 408 (70%) of patients were placed into the training cohort, and 177 (30%) patients were placed into the validation cohort. The 5- and 10-year CSS rates of stage I-II PMEC patients were 91.4 and 88.9, respectively. The 1-, 3- and 5-year CSS rates of stage III-IV PMEC were 56.5, 39.45, and 32.1%, respectively. Survival curves showed that older age, large tumor size, poor differentiation, and high TNM stage were associated with a significantly worse prognosis. CSS outcomes were significantly better in patients who received surgical treatments (surgical alone, surgery plus radiation and/or chemotherapy). Patients who received radiation and/or chemotherapy had the worst prognosis. Multivariate Cox results revealed that covariates, including age, tumor laterality, tumor sizes, pathological differentiation, lymph node metastasis, distant metastasis, TNM stage and therapy, were independent prognostic factors for PMEC. These factors were used to construct a nomogram. The C-index of the nomogram was 0.921. The calibration curve presented favorable consistency between the predicted CSS and actual observations. This nomogram was validated by the validation cohort. The C-index of the validation cohort was 0.968.

Conclusion

Age, bilateral tumors, tumor size, pathological differentiation grade, lymph node metastasis, distant metastasis, TNM stage and therapy were independent prognostic factors of PMEC patients. The first nomogram for predicting the CSS of PMEC was built and validated, showing its potential value in practice.

Nomogram for predicting the survival rate of primary pulmonary mucoepidermoid carcinoma patients: a retrospective study based on SEER database

Background

Primary pulmonary mucoepidermoid carcinoma (PMEC) is a rare malignant tumor, and the clinical manifestations lack specificity. The study evaluates the prognostic factors and constructs a practicable nomogram to estimate the individualized survival status for PMEC patients.

Methods

Surveillance, Epidemiology, and End Results (SEER) database was used to selected eligible patients between 1975 and 2016. The baseline characteristics including age, sex, race, marital status, tumor stage, differentiated degree, tumor laterality, primary tumor site, tumor size, lymph node metastases status, distant metastases status, surgery, chemotherapy, and radiation. We identified independent variables to build 3-, 5-, 10-year overall survival (OS) and cancer-specific survival (CSS) nomograms by univariate and multivariate analyses.

Results

A total of 438 PMEC patients met our selection criteria. In multivariate analysis, age, tumor stage, differentiated grade, tumor size, lymph node metastases status, distant metastases status, surgery and radiation were involved in the nomogram. The C-index (0.887 (95% CI: 0.863-0.911), calibrate plots and ROC curves (AUC =0.941, 0.951, 0.935 for 3-, 5-, 10-year OS, respectively) indicated the satisfied accuracy and practicability of our nomograms. Compared to TNM system, our model also showed a superior prediction (IDI =0.167, 0.171, 0.172, P<0.001).

Conclusions

We built OS (CSS) nomograms that can accurately estimate individualized survival time and identify the risk classification of PMEC.

Resolution of asthmatic symptoms following successful endoscopic resection of tracheal mucoepidermoid carcinoma

Mucoepidermoid carcinoma (MEC) is a rare tumour of the trachea accounting for up to 0.2% of reported primary lung malignancy. We report a case of a 54-year-old man, ex-smoker, whose presentation mimicked adult onset asthma with cough and wheezing, which did not respond to conventional treatment. He had occasional haemoptysis and weight loss in which CT scan performed for malignancy screening showed a protruding mass in the distal trachea causing endobronchial obstruction. Bronchoscopic intervention was performed to relieve the obstruction that resulted in resolution of asthmatic symptoms. Histological diagnosis confirmed MEC. This case emphasised the importance of a high index of suspicion in an unusual presentation of a common disease and the pivotal role of bronchoscopic intervention in malignant central airway obstruction.

Primary salivary gland-type tumors of the lung: A systematic review and pooled analysis

Introduction

Primary salivary gland-type tumors of the lung (PSGTTL) are rare intrathoracic malignant neoplasms. Their description in literature is largely limited to a few case series and case reports. A systematic review and pooled analysis of the previously reported cases of PSGTTL is presented here.

Methods

Electronic database of PubMed using keywords "lung neoplasm" AND "salivary gland tumors" was used to identify the papers documenting the PSGTTL. Filters (publication date from January 1, 1900--December 31, 2015, Humans and English) were applied to refine the search. A pooled analysis of clinical, pathological, treatment, and survival data was performed.

Results

The present systematic review included 5 studies and a total of 233 patients. Mean age of the patients was 41 years (range 6-80 years) and there was a male preponderance (1.3:1). Common pathological types were mucoepidermoid (MEC) (56.6%), adenoid cystic (ACC) (39.5%), and epithelial-myoepithelial cancer (3.8%). Tumors were located in the central airways (trachea and major bronchi) in 43.3% of patients. Weighted median tumor size was 4.2 cm. Surgery was the primary treatment undertaken in 82.4% of the patients, while radiotherapy and chemotherapy were also used in 15.9% and 9.4% of the patients. Lymph node involvement was seen in 15.2% of the patients. Disease recurrences were observed in 21.1% of the patients (12.9% and 37.5% in MEC and ACC, respectively). Three-, 5-, and 10-year weighted overall survival was 86.4%, 81.4%, and 73.6% (93.8%, 90.0%, and 85.0%, respectively, for MEC and 76.7%, 62.8%, and 50.5%, respectively, for ACC).

Conclusion

Surgery is the primary treatment of PSGTTL to achieve long-term survival. Role of chemotherapy and radiotherapy in the management of PSGTTL warrants further studies.

A Comparative Study of Primary Adenoid Cystic and Mucoepidermoid Carcinoma of Lung

Background

Pulmonary mucoepidermoid carcinoma (PMEC) and pulmonary adenoid cystic carcinoma (PACC) are the two major types of primary salivary gland-type (PSGT) lung cancers. The demographic profile, clinicopathological features, and predictors of survival as an overall group have not been described for PSGT cancers of lung.

Methods

In this study, we analyzed demographic, clinical, and survival data from 1,032 patients (546 PMEC and 486 PACC) who were diagnosed of PSGT lung cancer in the Surveillance, Epidemiology and End Results database from 1973 to 2014.

Results

The PSGT constituted 0.09% of all lung cancers with age-adjusted incidence rate of 0.07 per 100,000 person-years and change of −32% from 1973 to 2014. The incidence of PMEC was slightly higher than PACC but there were no differences in the age and sex distribution. PACCs (55%) were significantly higher at trachea and main bronchus while PMECs were more common at peripheral lungs (85%). Most of the tumors were diagnosed at an early stage and were low grade irrespective of histology. As compared to PMEC, significantly higher number of patients with PACC underwent radical surgery and received adjuvant radiation. The 1- and 5-year cause-specific survival was 76.6 and 62.8%, respectively. On multivariate analysis, the survival was affected by age at diagnosis, tumor stage, histological grade, period of diagnosis, and surgical resection. The histology showed strong interaction with time and hazard ratio of patients with PACC was significantly worse than patients with PMEC only after 5 years.

Conclusion

The incidence of pulmonary PSGT cancer is 7 cases per 10 million population in the United States and is decreasing. There was no difference between demographic profile of patients with PMEC and PACC but pathological features were diverse. The difference in the survival of patients with the two histological types surfaced only after 5 years when survival of patients with PMEC was better than PACC.

Surgical outcomes of pulmonary mucoepidermoid carcinoma: A review of 41 cases

INTRODUCTION

Pulmonary mucoepidermoid carcinoma is a rare cancer that occurs primarily in younger patients. The prognostic factors of pulmonary mucoepidermoid carcinoma are largely undetermined, especially in elderly patients. The aim of this study was to examine the clinical characteristics and prognostic factors influencing survival after surgical resection in patients with pulmonary mucoepidermoid carcinoma and also analyze the clinical manifestations and prognostic factors in elderly patients.

MATERIALS AND METHODS

The pathological records of 41 pulmonary mucoepidermoid carcinoma patients (mean age, 61.4 years) who underwent surgical resection at our hospital between January 1991 and July 2015 were retrospectively reviewed. Subjects >65 years of age (n = 22) were considered elderly.

RESULTS

The median follow-up duration was 42.9 (interquartile range, 15.0-120.8) months. Sixteen patients (39.0%) experienced tumor relapse, including 13 patients (81.3%) within 2 years. The 5-year disease-free survival rate was 57.9%. Tumor grade did not influence disease-free survival (P = 0.286). In the multivariate analysis, age, tumor size, pathological T3-4 status, and pathological N2 status were independent predictors of disease-free survival. The 5-year overall survival rate was 57.0%. Tumor grade also did not influence overall survival (P = 0.170). Age, tumor size, pathological T status, and pathological N2 status were independent predictors of overall survival. In elderly patients, the 5-year disease-free survival and overall survival rates were 41.4% and 41.5%, respectively. Pathological T status was the only independent predictor of both disease-free survival and overall survival in elderly patients.

CONCLUSIONS

Prognostic factors identified for pulmonary mucoepidermoid carcinoma in this study differ from those of previous studies. Principally, tumor grade did not influence either disease-free survival or overall survival. Age, tumor size, and pathological factors were independent predictors of disease-free survival and overall survival. In elderly patients, pathological T status was the only independent predictor of disease-free survival and overall survival.

Mucoepidermoid carcinoma of the airways in a young adult male

Mucoepidermoid carcinoma (MEC) of the airways is a rare entity most often found in young patients. We present a case of a 23 year old patient with symptoms of pneumonia, which progresses to a pulmonary abscess within a week. Diagnostic work-up reveals an endobronchial obstruction by a pedunculated low grade MEC. A literature review is provided and radiological appearances are described.

Primary mucoepidermoid carcinoma at the carina of trachea presenting with wheezing in an asthmatic child mimicking an attack of asthma: A case report

BACKGROUND

Asthma is a very common disease, but primary tracheal tumors are extremely rare in children. Wheezing is not pathognomonic, but is the typical presentation of asthma and could also be found in patients with tracheal tumors.

CLINICAL FINDINGS

This report describes a 12-year-old boy with a previous history of frequent asthma attacks and experienced responses to antiasthma treatment. He was admitted to the hospital due to persistent wheezing and progressive dyspnea. Hyperinflation in the bilateral lungs was detected on chest x-ray, but without other significant findings. Chest computed tomography revealed a mass at the carina. Tracheal mucoepidermoid carcinoma was diagnosed by histopathological assessment.

CONCLUSION

Despite the rarity of tracheal tumors, chest computed tomography scans should be performed in the first place for children presenting persistent wheezing and having poor response to antiasthma treatment to rule out the other alternative diagnosis. Coexistence of other diseases such as tracheal tumor in asthmatic patients should be considered.

Childhood and adolescent tracheobronchial mucoepidermoid carcinoma (MEC): a case-series and review of the literature

Tracheobronchial mucoepidermoid carcinomas (MEC) are rare in the pediatric population with literature limited primarily to case reports. Here we present our institutional experience treating MEC in three patients and review the literature of 142 pediatric cases previously published from 1968 to 2013. Although rare, tracheobronchial MEC should be included in the differential diagnosis in a child with recurrent respiratory symptoms. Conservative surgical management is often sufficient to achieve complete resection and good outcomes.

Low-Grade and High-Grade Mucoepidermoid Carcinoma of the Lung: CT Findings and Clinical Features of 17 Cases

OBJECTIVE

The objective of our study was to characterize the CT features and clinical findings of low-grade and high-grade mucoepidermoid carcinoma (MEC) of the lung.

MATERIALS AND METHODS

The CT findings and clinical information of 17 consecutive patients with primary low-grade (n = 11) or high-grade (n = 6) MEC were analyzed retrospectively. We assessed tumor location, size, contour, margin, density, calcification, obstructive changes, presence of metastasis, and enhancement.

RESULTS

In patients with low-grade MEC, tumor location was central in 10 and peripheral in one. In contrast, one and five tumors in patients with high-grade MEC were central and peripheral, respectively. There was a significant difference between central and peripheral locations among tumor grades (p = 0.005). In low-grade MECs, tumor contour was smoothly oval (n = 3) or spheric (n = 4); four were lobular. In five patients with low-grade MEC, tumors had well-defined margins; margins in the other six were poorly defined. Tumor density was homogeneous and heterogeneous in eight and three low-grade tumors, respectively. All six high-grade tumors had heterogeneous density, lobular contours, and poorly defined margins. Enhancement in both low-grade and high-grade tumors was greater than that of chest wall muscles, and low-grade tumors showed greater enhancement (46.90 ± 20.44 HU) than did high-grade tumors (22.50 ± 8.38 HU) (p = 0.015).

CONCLUSION

A markedly enhanced homogeneous central bronchial nodule or mass may suggest low-grade MEC. High-grade MEC tends to be peripheral, to have poorly defined margins, and to be lobular, heterogeneous nodules or masses with less enhancement.

Prediction of Pathologic Grade and Prognosis in Mucoepidermoid Carcinoma of the Lung Using ¹⁸F-FDG PET/CT

Objective

The maximum standardized uptake value (SUV_max) of pulmonary mucoepidermoid carcinoma (PMEC) in fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) was evaluated as a preoperative predictor of pathologic grade and survival rate.

Materials and Methods

Twenty-three patients who underwent preoperative PET/CT and complete resection for PMEC were enrolled. The optimal cut-off SUV_max for tumor grade was calculated as 6.5 by receiver operating characteristic curve. The patients were divided into a high SUV group (n = 7) and a low SUV group (n = 16). Clinicopathologic features were compared between the groups by χ² test and overall survival was determined by Kaplan-Meier analysis.

Results

The mean SUV_max was 15.4 ± 11.5 in the high SUV group and 3.9 ± 1.3 in the low SUV group. All patients except one from the low SUV group had low grade tumors and all had no nodal metastasis. The sensitivity and specificity of SUV_max from PET/CT for predicting tumor grade was 85.7% and 93.8%, respectively. During the follow-up period (mean, 48.6 ± 38.7 months), four patients from the high SUV group experienced cancer recurrence, and one died of cancer. In contrast, none of the low SUV group had recurrence or mortality. Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031).

Conclusion

Pulmonary mucoepidermoid carcinoma patients with high SUV_max in PET/CT had higher tumor grade, more frequent lymph node metastasis and worse long-term outcome. Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.

[Mucoepidermoid tracheo-bronchial tumors in adulthood. A series of 22 cases]

INTRODUCTION

Mucoepidermoid tumours (TME) are rare tumours arising from the submucosal glands of the tracheobronchial tree. The majority of these tumours develop in a benign fashion but some of them are malignant. The latter can be easily mistaken for adenosquamous carcinomas.

PATIENTS AND METHOD

We have reviewed 22 patients suffering from TME observed over a period of 25 years. Two arose from the trachea and 20 from the cartilaginous bronchi; 12 of these tumours had macroscopic and histological criteria of low-grade malignancy, 4 had macroscopic and 6 macroscopic and microscopic criteria of high grade malignancy.

RESULTS

Prognosis of the latter was very poor and no survival observed after 6 years follow-up, a behavior similar to that observed in non-small cell lung carcinomas and adenosquamous carcinomas.

CONCLUSION

The best treatment of these orphan tumours remains surgery.

Mucoepidermoid carcinoma of lung masquerading as urothelial carcinoma of bladder

BACKGROUND

Mucoepidermoid carcinoma (MEC) of the lung is a rare subtype of non-small cell lung cancer. There is no consensus regarding optimal management for this disease.

CASE REPORT

We present a case of MEC of the lung in a 75 year-old female with a history of superficial urothelial carcinoma of the bladder. The patient was found to have an asymptomatic lung mass. Initial biopsy suggested metastatic recurrence of urothelial carcinoma and therefore, cisplatin and gemcitabine chemotherapy was administered prior to surgical resection. Pathological analysis of the resected specimen confirmed a diagnosis of stage IIIA MEC with focal high-grade features including transitional cell-like areas. Adjuvant radiotherapy was administered due to a positive microscopic resection margin. No chemotherapy was given due to lack of supporting data. The patient developed widespread metastatic disease 3 months following completion of radiotherapy and died 1 month later.

CONCLUSION

This case demonstrates the possibility of dual pathology in cases where metastatic disease is suspected. The use of small tissue samples may complicate diagnosis due to the heterogeneity of malignant tumours.

Mucoepidermoid lung carcinoma in child

Mucoepidermoid carcinoma (MEC) is a rare malignant tumor arising from the bronchial gland. A case of 6-year-old male child who presented with fever, hemoptysis and wheezing since 1month is reported. Chest X-ray showed features suggestive of foreign body with post-obstructive pneumonia and was treated for the same with medication without much improvement. Subsequently computerized tomography scan chest was carried out, which showed oval mass with speculated margin in right hilar region with distal segmental atelectasis. Bronchoscopy showed small growth with nodularity in the apical segmental bronchus of the right lower lobe with mucosal erosion and hence carried out broncho-alveolar lavage showed few atypical squamous cells. Patient underwent right lower lobectomy, which showed a grey white oval mass with solid and cystic areas in the right hilar region with extension in to the lung parenchyma. Histology of the tumor showed mixed solid and cystic areas with sheets of epidermoid cells and mucus-filled cysts of irregular size. Areas of solid growth were composed of squamoid and intermediate cells. Hence, the final diagnosis of mucoepidermoid carcinoma (MEC) intermediate grade of the lung was made. Early diagnosis can be accomplished if the clinician is alert to persistent pneumonia, coughing and tumor obstruction on image studies. MEC is a comparatively rare low-grade tumor, which reportedly carries a good prognosis with early surgical intervention.

A case of pulmonary mucoepidermoid carcinoma responding to carboplatin and paclitaxel

A 59-year-old man was admitted to our hospital with dyspnea and cough. A large polypoid tumor was observed in the lower trachea and bronchoscopic polypectomy was performed using a snare to relieve symptoms. The tumor was diagnosed as a high grade mucoepidermoid carcinoma mainly by the histology of piecemeal specimens obtained by bronchoscopic resection. The primary lesion involved the trachea and the main bronchus, and there were multiple metastases in the lung. The patient was treated with the combination of carboplatin and paclitaxel. After four cycles of chemotherapy, the tumors were significantly reduced. He remains well without evidence of tumor progression for 25 months. This case suggests that the combination chemotherapy of carboplatin and paclitaxel can be an option for treatment of pulmonary mucoepidermoid carcinoma.

Pulmonary adenosquamous carcinoma with mucoepidermoid carcinoma-like component with characteristic p63 staining pattern: either a novel subtype originating from bronchial epithelium or variant mucoepidermoid carcinoma

BACKGROUND

Our previous study found unique adenosquamous carcinomas (ADSQs) containing a mucoepidermoid carcinoma (MEC)-like component and a characteristic p63 staining pattern. This study focused on these unique ADSQs.

METHODS

Thirty ADSQ cases were studied histologically and by immunohistochemistry for TTF-1 and p63. Of these 30 ADSQs, eight were selected as unique ADSQs. The clinicopathological characteristics of these ADSQs were further studied, and the gene rearrangement of mammalian mastermind-like 2 (MAML2) was investigated by fluorescence in situ hybridization (FISH) for differentiation from pulmonary MEC.

RESULTS

The clinicopathological characteristics between the eight ADSQs and the other ADSQ cases showed no statistically significant differences, except for serum CEA level. Histologically, the eight ADSQs contained varying degrees of the MEC-like component, which consisted of solid nests with mucin-filled cysts or a cribriform-like structure. Immunohistochemically, p63-positive nuclei characteristically encircled the tumor nests, although TTF-1 was completely negative. All unique ADSQs not only had a variable degree of squamous cell carcinoma component in addition to the MEC-like component, but also contained a small tubular adenocarcinoma component in three tumors. FISH analysis revealed no MAML2 gene rearrangement in the eight ADSQs.

CONCLUSIONS

Of the 30 ADSQs investigated in this study, eight contained a MEC-like component with a characteristic p63 basilar staining pattern similar to that of bronchial basal cells. These unique ADSQs shared clinical characteristics with ordinary ADSQs, but clinicopathologically differed from pulmonary ordinary MEC. Therefore, these unique ADSQs may be either a novel ADSQ subtype originating from bronchial epithelium or variant-type MEC.

Mucoepidermoid carcinoma of the lung: a case report and literature review

Introduction. Mucoepidermoid carcinoma (MEC) of the lung is a rare form of lung cancer that is classified into low grade and high grade based on histological features. Surgical resection is the primary treatment for low-grade MEC with excellent outcomes, while high-grade MEC is a more aggressive form of malignancy. Clinical Case. We report a case of a 46-year-old woman who presented with dyspnea on exertion. Imaging studies revealed a mass involving the right upper lobe bronchus. Bronchoscopy, surgical resection, and pathological examination revealed a low-grade MEC with tumor-free margins. No adjuvant treatment was given. Discussion. Primary pulmonary MEC is a rare type of lung cancer with only few reported cases. This patient illustrates a typical presentation for low-grade MEC wherein surgical resection is considered curative. In contrast, high-grade MEC is a more aggressive malignancy with a poorer outcome. The role of targeted therapy directed against EGFR or a novel CRTC1-MAML2 fusion protein expressed in some high-grade tumors is yet to be determined.

Primary salivary gland-type lung cancer: imaging and clinical predictors of outcome

OBJECTIVE

The objective of our study was to assess whether CT features and FDG up-take of primary salivary gland-type tumors of the lung are associated with tumor type, disease stage, or survival.

MATERIALS AND METHODS

CT (n = 30) and PET (n = 15) data of 30 consecutive patients with primary salivary gland-type tumors of the lung were retrospectively evaluated for tumor size, location, and homogeneity and the presence of lymphadenopathy, pleural effusions, and metastases. Maximum FDG uptake and volumetric FDG uptake of the tumors were recorded. The Wilcoxon rank sum and Fisher exact tests and univariate Cox regression were used for statistical calculations.

RESULTS

Compared with mucoepidermoid carcinomas, adenoid cystic carcinomas (57%) were larger (mean, 3.5 vs 2.2 cm, respectively; p = 0.03), more frequently involved the central airways (94% vs 63%; p = 0.002), and had a higher median FDG uptake (p = 0.0264). Higher FDG uptake of the primary tumor was associated with nodal tumor involvement (p = 0.05). The median overall survival times for patients with adenoid cystic carcinoma and mucoepidermoid carcinoma were 7.7 and 4.0 years, respectively. Imaging features that significantly affected overall survival included the presence of mediastinal or hilar lymphadenopathy (hazard ratio [HR], 4.33; 95% CI, 1.15-16.26; p = 0.03), suspected metastatic disease (HR, 5.10; 95% CI, 1.27-20.47; p = 0.02), and primary tumor heterogeneity (HR, 3.46; 95% CI, 1.04-11.55; p = 0.04).

CONCLUSION

Higher FDG uptake is associated with nodal disease in patients with primary salivary gland-type tumors of the lung but is not predictive of survival, whereas CT features suggestive of advanced disease correlate with worse outcome.

About a submucosal tracheal tumor

The authors report the case of 46-year-old man with recurrent hemoptysis. Bronchoscopy revealed a submucosal tumor protruding into the tracheal lumen. Transbronchial biopsy failed to obtain a conclusive diagnosis; only surgery allowed complete resection of the tumor and confirmed the diagnosis of tracheal mucoepidermoid carcinoma. We discuss the unusual submucosal presentation of this tumor, and the contribution of surgery for diagnosis and therapy.

Primary salivary type lung tumor: Mucoepidermoid carcinoma

Primary salivary type lung cancer are extremely rare intrathoracic malignancies. Mucoepidermoid tumor is one of the salivary gland tumor which originates from submucosal glands of tracheobronchial tree. These are very slow growing low grade malignant tumors. Surgery is the mainstay of treatment and rarely requires adjuvant therapy. In this case report, we describe a case of a young male who presented with cough and hemoptysis. On further investigation he was found to have mucoepidermoid tumor originating from the left bronchus.

Primary tracheobronchial mucoepidermoid carcinoma--a retrospective study of 32 patients

Background

This retrospective study was designed to investigate the clinical characteristics, diagnosis, treatment and prognosis of primary tracheobronchial mucoepidermoid carcinoma (MEC).

Methods

Clinical data were retrospectively analyzed from 32 patients with pathologically confirmed primary tracheobronchial MEC between January 1990 and December 2010 at Zhejiang Cancer Hospital. The Kaplan-Meier methods were used to estimate and compare survival rates.

Results

There were 19 males and 13 females ranging in age from 7 to 73 years, with a median age of 28 years. Twenty-six of the 32 patients were treated with surgery alone. The other six patients were treated with surgery plus postoperative radiotherapy or chemotherapy. Six patients died during the follow-up time. The overall five-year survival rates were 81.25%, whereas the five-year survival rate of seven patients with high-grade tumors was only 28.6%. Stage I and II patients experienced better survival than Stage III and IV patients (the five-year survival rate was 100% and 43.6% respectively, P<0.001).

Conclusions

Primary tracheobronchial MEC is a rare disease. Histologic grading and TNM (tumor-node-metastasis)staging are independent prognostic factors. Surgical resection is the primary treatment.

Bronchial mucoepidermoid carcinoma: an unusual cause of complex cystic lung mass in a young man

Bronchial mucopeidermoid carcinoma is extremely rare, with an incidence of 0.1 to 0.2% of all primary lung tumors. It usually presents as an endobronchial mass with either partial or total occlusion of the airway lumen. Common clinical presentations are hemoptysis, airway obstruction, and recurrent atelectasis or pneumonia. We present a 27-year-old man who complained of chronic cough as a result of bronchial mucopeidermoid carcinoma with resultant obstructive lung changes.

Primary pulmonary mucoepidermoid carcinoma: an analysis of 21 cases

Background

The optimal treatment for pulmonary mucoepidermoid carcinoma (MEC), a rare type of tumor, has not been established yet. This study analyzed the survival of pulmonary MEC patients and attempted to find clues for optimal treatment.

Methods

A total of 21 patients with pulmonary MEC from November 2004 to January 2011 were included in the investigation. Immunohistochemistry, epidermal growth factor receptor (EGFR) mutation, and survival were retrospectively studied.

Results

Among the 21 pulmonary MEC patients, 17 were diagnosed with low-grade malignancy and 4 with high-grade malignancy through pathological examination. The prognosis was found to be poor in the presence of lymph nodes. The expression rates of EGFR and HER2 were 28.6% and 0%, respectively, which correlated with neither grade nor prognosis. The mutation rate of EGFR was 0. Log-rank test results indicated that age, grade, lymph node metastasis, and tumor-node-metastasis stage were prognostic factors.

Conclusion

Age, grade, lymph node metastasis and tumor-node-metastasis stage correlate with the survival of pulmonary MEC patients.

Trial registration

This study was approved and registered by the Ethics Committee of Zhongshan Hospital. Written informed consent was obtained from all participants prior to treatment.

Comparative expression of matrix metalloproteinases in low-grade mucoepidermoid carcinoma and typical lung cancer

The molecular profile of low-grade mucoepidermoid carcinomas remains to be clarified. In the present study, matrix metalloproteinase (MMP) expression was compared in low-grade mucoepidermoid carcinoma (MEC) and typical lung cancer. The expression of MMP-2, MMP-7 and MMP-9 was detected by immunohistochemistry in a cohort of 110 patients (34 with low-grade MEC and 76 with matched typical lung cancers). A positive MMP-2 expression was found to be 35.29 vs. 65.79% in low-grade MEC and typical NSCLCs (p=0.003); a positive MMP-7 expression was 41.18 vs. 55.26% (p=0.172); and a positive MMP-9 expression was 35.29 vs. 57.89% (p=0.028). In conclusion, the expression of MMP-2 and MMP-9 in low-grade MEC is lower than that in typical lung carcinomas.

Radical mediastinal nodal removal improves disease-free survival for pulmonary low-grade malignant tumors

PURPOSE

To investigate the prognostic role of radical lymph node dissection in treatment for pulmonary Low Grade Malignant Tumors (LGMTs); specifically, on the extent of nodal removal and its impact on long-term survival.

METHODS

A total of 93 LGMTs cases underwent surgical resection and were histopathologically confirmed. Overall survival rates and disease-free survival were respectively calculated according to the extent of lymph node resection and histopathological grades of tumors. Risk factors of nodal involvement and survival predictors were calculated via multivariate analysis. Life table, Kaplan-Meier, and Cox regression models were used for the statistical analysis.

RESULTS

Thirty-eight cases of carcinoid, 17 adenoid cystic carcinomas, and 38 mucoepidermoid carcinomas were included in the current study. Twenty-one cases were high-grade and 72 were low-grade. A total of 813 lymph nodes were removed, at an average of 8.7±5.4 nodes per patient. The numbers of harvested nodes were 11.8±4.5, in the study group via radical nodal removal and 4.0±2.4 nodes per patient in the nodal sampling group. Eleven cases showed lymph nodal involvement (5 mediastinal and 6 hilar lymph node metastasis). No significant differences of overall survival was found among the different histological types (p=0.939), or the extent of nodal removal (p=0.971). Meanwhile, there was a significant difference of disease-free survival (DFS) rates according to the extent of nodal removal (5-YS: 97% of radical nodal dissection vs. 78% of nodal sampling, p=0.038). Overall survival and disease-free survival were closely associated with histological grading (OS: 78% of high grade vs. 97% of low grade, p=0.001; DFS: 57% of high grade vs. 97% of low grade, p<0.0001).

CONCLUSIONS

Radical lymph node dissection improved disease-free survival for pulmonary low-grade malignant tumors, although no obvious improvement on overall survival was noticed. Histological grade was the most important prognostic factor in LGMTs.