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Naso JR, Roden AC. Recent developments in the pathology of primary pulmonary salivary gland-type tumours. Histopathology 2024; 84:102-123. [PMID: 37694812 DOI: 10.1111/his.15039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
Primary pulmonary salivary gland-type tumours are rare neoplasms that are thought to arise from seromucinous glands that are located in the submucosa of large airways. These neoplasms have clinical and pathologic features that are distinct from other pulmonary neoplasms. The majority of primary pulmonary salivary gland-type tumours are malignant, with the most common entities being mucoepidermoid carcinoma, adenoid cystic carcinoma, and epithelial-myoepithelial carcinoma. Less commonly seen are myoepithelial carcinoma, hyalinizing clear cell carcinoma, acinic cell carcinoma, secretory carcinoma, salivary duct carcinoma, intraductal carcinoma, and polymorphous adenocarcinoma. Benign salivary gland-type tumours of the lung include pleomorphic adenoma and sialadenoma papilliferum. Morphologic, immunophenotypic, and molecular features of these neoplasms are largely similar to salivary gland tumours elsewhere, and therefore the exclusion of metastatic disease requires clinical and radiologic correlation. However, the differential diagnostic considerations are different in the lung. The distinction of salivary gland-type tumours from their histologic mimics is important for both prognostication and treatment decisions. Overall, salivary gland type-tumours tend to have a more favourable outcome than other pulmonary carcinomas, although high-grade variants exist for many of these tumour types. Recent advances in our understanding of the spectrum of salivary gland-type tumours reported in the lung and their diversity of molecular and immunohistochemical features have helped to refine the classification of these tumours and have highlighted a few differences between salivary gland-type tumours of the lung and those primary to other sites.
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Affiliation(s)
- Julia R Naso
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
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Detection of Changes in CEA and ProGRP Levels in BALF of Patients with Peripheral Lung Cancer and the Relationship with CT Signs. CONTRAST MEDIA & MOLECULAR IMAGING 2023; 2023:1421709. [PMID: 36851977 PMCID: PMC9966566 DOI: 10.1155/2023/1421709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 02/20/2023]
Abstract
Objective To investigate the relationship between the detection of changes in the levels of carcinoembryonic antigen (CEA) and progastrin-releasing peptide (ProGRP) in bronchoalveolar lavage fluid (BALF) and CT signs in patients with peripheral lung cancer. Methods Retrospective analysis of 108 patients with perihilar lung cancer who attended our hospital from January 2019 to January 2022, 54 cases were randomly selected as the observation group and 50 cases as the control group. Patients in both groups received CT examination and BALF test at the same time to observe and compare the differences in serum levels, the relationship between CT signs and serum indices, and the diagnostic value of peripheral lung cancer between the two groups. Results The serum levels of ProGrp, CEA, CA211, and NSE in the observation group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The morphology, density, mass enhancement pattern, bronchial morphology, obstructive signs, and lymph node fusion of CT signs were compared between the observation group and the control group, indicating that CT signs were more helpful for the localization, diagnosis, and staging of lung cancer. The results of ROC curve analysis showed that the AUC value of low-dose CT combined with serum ProGrp, CEA, CA211, and NSE was 0.892, sensitivity was 96.21%, and specificity of 90.05%, which were significantly higher than those of the single tests, respectively. The positive likelihood ratio was 84.41% and the negative likelihood ratio was 87.11%. Conclusion The combination of CT signs and serum tumour markers helps to improve the detection rate, sensitivity, and specificity of lung cancer, which has a high diagnostic rate for lung cancer and may provide evidence for the early diagnosis of lung cancer.
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Pulmonary Epithelial-Myoepithelial Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:4559550. [PMID: 36268279 PMCID: PMC9578788 DOI: 10.1155/2022/4559550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022]
Abstract
Pulmonary epithelial-myoepithelial carcinoma (P-EMC) is an exceptionally rare subtype of salivary gland lung tumor originating from tracheobronchial glands. P-EMC is a biphasic tumor consisting of an inner layer of epithelial cells and an outer layer of spindle-shaped, clear-cell-like myoepithelial cells. Bronchial obstruction symptom is the main clinical characteristic for P-EMC. Because its clinical and imaging characteristics are highly similar to other types of non-small-cell lung cancer (NSCLC), it is easy to cause missed diagnosis and misdiagnosis. The diagnosis is mainly based on the pathology and immunohistochemistry with an inner layer of epithelial cells immunoreactive for cytokeratin and an outside layer of myoepithelial cells immunoreactive for S100 protein (S-100) and smooth muscle actin (SMA). Therefore, positive for cytokeratin, S-100 and SMA can assist in the diagnosis. Although in general, P-EMC is a low-grade malignant neoplasm, it may occasionally recur and metastasize. The optimal method for P-EMC treatment has not been established, and surgical resection is still the main clinical method. Radiotherapy and chemotherapy have been shown not sensitive for P-EMC treatment, whereas targeted therapy and immunotherapy have not evaluated in clinical practice. This review focuses on the pathological characteristics, molecular characteristics, diagnosis, treatment, and prognosis of P-EMC.
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Zhang W, Wang XX, Wang XL, Zhang Y, Li XF, Li Y, Cai YY, Ren HQ, Zhang YX, Hao FR. Epithelial–myoepithelial carcinoma of the nasopharynx: A case report and review of the literature. Front Oncol 2022; 12:923579. [PMID: 35992786 PMCID: PMC9389165 DOI: 10.3389/fonc.2022.923579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEpithelial–myoepithelial carcinoma (EMCa) is a rare low-grade malignant tumor that most commonly occurs in the salivary glands, with approximately 320 cases having been reported worldwide. Here, we report the third case of EMCa occurring in the nasopharynx. Rare cases in the breast, pituitary gland, lacrimal gland, nose, paranasal sinus, nasal cavity, trachea and bronchus, lung, and even the pleura mediastinalis have also been reported. Histopathology and immunohistochemistry are useful for confirming the diagnosis of EMCa, which is characterized by biphasic tubular structures composed of inner ductal and outer clear myoepithelial cells and stains for different markers in each layer. However, because of the rarity of EMCa, the clinicopathological characteristics and treatment of these patients remain unclear.Case presentationWe report a rare case of EMCa of the nasopharynx. A 51-year-old man presented with a 5-month history of pain while swallowing and aggravation accompanied by right ear tinnitus lasting for 1 month. Nasopharyngoscopy and magnetic resonance imaging (MRI) of the nasopharynx and neck revealed a 5.6 cm × 3.4 cm × 3.1 cm mass in the nasopharyngeal space, invasion of the right cavernous sinus, and lymph node enlargement in the right retropharyngeal space. On 17 April 2019, based on the histopathological and immunohistochemical features, a final diagnosis of EMCa of the right nasopharynx was made. The patient underwent concurrent chemoradiotherapy (CCRT), and his symptoms were relieved after treatment. On 10 January 2022, nasopharynx MRI and biopsy revealed local recurrence, but chest and abdominal computed tomography (CT) showed no obvious signs of metastasis. The local recurrence-free survival (LRFS) period was 33 months.ConclusionTo the best of our knowledge, this is the third reported case of EMCa in the nasopharynx and the only case of EMCa in the nasopharynx treated with CCRT, and a partial response was achieved. Therefore, to improve the quality of life and prognosis of patients with unresectable tumors, we believe that CCRT is a suitable option. Further clinical observations are required to elucidate the pathophysiology and prognosis of EMCa.
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Affiliation(s)
- Wei Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Xiao-xiao Wang
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Xiao-li Wang
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Yan Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Xiu-feng Li
- Department of Pathology, Weifang People’s Hospital, Weifang, China
| | - Yang Li
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Yuan-yuan Cai
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Hui-qi Ren
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Yun-xiang Zhang
- Department of Pathology, Weifang People’s Hospital, Weifang, China
- *Correspondence: Fu-rong Hao, ; Yun-xiang Zhang,
| | - Fu-rong Hao
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China
- *Correspondence: Fu-rong Hao, ; Yun-xiang Zhang,
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Mohanty S, Sharma S, Tayal A, Khatri S, Mohapatra S. Primary pulmonary epithelial-myoepithelial carcinoma: Report of a rare and under-diagnosed low-grade malignancy. J Cancer Res Ther 2022; 18:795-800. [DOI: 10.4103/jcrt.jcrt_559_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chen L, Li Q, Fu G, Ge M. [A Rare Case of Pulmonary Epithelial-myoepithelial Carcinoma: Case Report and Literature Review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:127-132. [PMID: 32093457 PMCID: PMC7049792 DOI: 10.3779/j.issn.1009-3419.2020.02.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
背景与目的 肺上皮-肌上皮癌(pulmonary epithelial-myoepithelial carcinoma, P-EMC)是一种十分罕见的涎腺型肺肿瘤,尚无标准治疗方案,本文拟分析肺上皮-肌上皮癌的临床特点,探讨肺上皮-肌上皮癌的诊疗方案。 方法 分析1例肺上皮-肌上皮癌患者的临床资料并回顾其他相关临床文献。 结果 上皮细胞免疫组化表达细胞角蛋白,肌上皮细胞免疫组化表达SMA及S-100,二代基因测序以HRAS基因突变为主,PD-L1蛋白为阴性。 结论 肺上皮-肌上皮癌大多预后良好,诊断以镜检及免疫组化为主,治疗以手术切除为主,放化疗效果尚不明确。
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Affiliation(s)
- Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qingshu Li
- Department of Pathology, Chongqing Medical University, Chongqing 400016, China
| | - Guang Fu
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Mingjian Ge
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Yanagawa N, Sato A, Nishiya M, Suzuki M, Sugimoto R, Osakabe M, Uesugi N, Saito H, Sugai T. Pulmonary epithelial-myoepithelial carcinoma without AKT1, HRAS or PIK3CA mutations: a case report. Diagn Pathol 2020; 15:105. [PMID: 32859224 PMCID: PMC7456004 DOI: 10.1186/s13000-020-01020-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/21/2020] [Indexed: 01/17/2023] Open
Abstract
Background Pulmonary epithelial–myoepithelial carcinoma is a rare subtype of lung cancer. Because of its rarity, the molecular information on this carcinoma is insufficient. Case presentation We report a case of pulmonary epithelial–myoepithelial carcinoma without AKT1, HRAS or PIK3CA mutations in a 76-year-old woman. Computed tomography revealed a tumor located in the left lower lung. Thoracoscopic left lower lobectomy was performed. Histopathologically, the tumor consisted of duct-like structures and polygonal and spindle cell features. The duct-like structures were composed of two distinct cell layers. The inner layer consisted of cuboidal cells that were positive for pan-cytokeratin and negative for p63, whereas the outer layer consisted of polygonal and spindle cells that were positive for p63 and weakly positive for pan-cytokeratin. We evaluated mutations in AKT1, BRAF, CTNNB1, HRAS, KRAS and PIK3CA but did not detect any mutations. Conclusion Pulmonary epithelial–myoepithelial carcinoma is a rare subtype of lung cancer, with only 56 previous cases reported in the English literature. The genetic alterations in pulmonary epithelial–myoepithelial carcinoma are still unknown. We examined the 6 genes mutation analysis, however no mutation was detected.
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Affiliation(s)
- Naoki Yanagawa
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan.
| | - Ayaka Sato
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan
| | - Masao Nishiya
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan
| | - Masamichi Suzuki
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan
| | - Ryo Sugimoto
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan
| | - Mitsumasa Osakabe
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan
| | - Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Iwate Medical University, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 0283695, Japan
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Nakashima Y, Morita R, Ui A, Iihara K, Yazawa T. Epithelial-myoepithelial carcinoma of the lung: a case report. Surg Case Rep 2018; 4:74. [PMID: 29987577 PMCID: PMC6037657 DOI: 10.1186/s40792-018-0482-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 07/02/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Pulmonary epithelial-myoepithelial carcinoma (P-EMC) is a rare subset of salivary gland-type tumors of the lung. Because of its rarity and unproven malignant potential, the optimal therapy for P-EMC has not been defined. Here, we report a typical case of P-EMC and a review of the literature to consider appropriate treatment. CASE PRESENTATION A 54-year-old woman presented with an abnormal lung shadow on a routine chest X-ray. A chest computed tomography (CT) scan verified an 18-mm endobronchial nodule on the middle lobe. We performed a bronchoscopic biopsy, and the patient was diagnosed with P-EMC. After confirming the absence of tumors in the salivary glands, she underwent a right middle lobectomy along with hilar and mediastinal lymph node dissections. Currently, the patient is doing well, without any sign of recurrence 3 years after surgery. CONCLUSIONS Although a majority of P-EMC cases, as in our case, behave indolently, several poor progression cases have been reported. For distinguishing the minor malignancy cases from others, histological findings such as myoepithelial anaplasia could be a predictive factor. Complete resection is needed to evaluate the whole tumor, because P-EMCs often show histological heterogeneity. Moreover, incomplete excision may be a poor prognostic factor. Although lobectomies as well as lymph node dissections, sleeve lobectomies, or pneumonectomies are routinely performed for complete resection, further investigation is required to establish the optimal treatment strategy.
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Affiliation(s)
- Yasuhiro Nakashima
- Department of Chest Surgery, Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo, 169-0073 Japan
- Department of Thoracic Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Riichiro Morita
- Department of Chest Surgery, Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo, 169-0073 Japan
| | - Akiko Ui
- Department of Chest Surgery, Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo, 169-0073 Japan
- Department of Thoracic Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Kuniko Iihara
- Department of Pathology, Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo, 169-0073 Japan
| | - Takuya Yazawa
- Department of Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293 Japan
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Zhou X, Yu M, Zhuo H, Zhang S. Primary pulmonary myoepithelial carcinoma in a young woman: A case report and review of literature. Medicine (Baltimore) 2018; 97:e0049. [PMID: 29489660 PMCID: PMC5851772 DOI: 10.1097/md.0000000000010049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/03/2018] [Accepted: 02/09/2018] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Myoepithelial carcinoma mainly occurs in the salivary glands, but myoepithelial carcinoma of the lung is extremely rare neoplasm whose biological behavior and clinical course still remain to be fully elucidated. Although considered as low-grade carcinoma, these tumors have a high rate of recurrence or distant metastasis. PATIENT CONCERNS To date there are only 11 cases of pulmonary myoepithelial carcinoma reported in the English literature. We report a case of a 24-year-old woman diagnosed with primary pulmonary myoepithelial carcinoma. Informed consent was obtained from the patient. DIAGNOSES The tumor derived from superior lobe of left lung and exhibited only myoepithelial differentiation without any ductal formation by histopathological and immunohistochemical analysis. INTERVENTIONS The patient underwent the left superior lobe resection. In addition, we first introduce second-generation sequencing technology as a novel strategy for primary pulmonary myoepithelial carcinoma, and these tumors should be included in the differential diagnosis of thoracic neoplasms. OUTCOMES The patient was alive with no evidence of disease for up to 12 months. LESSONS Individualized treatment is the promising clinical strategy for thoracic neoplasms, and the underlying molecular events should be investigated to find the potential therapeutic targets.
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Affiliation(s)
- Xiaojuan Zhou
- Department of Thoracic Oncology, West China Hospital, Sichuan University
| | - Min Yu
- Department of Thoracic Oncology, West China Hospital, Sichuan University
| | - Hongyu Zhuo
- Department of Oncology, Shang Jin Nan Fu Hospital
| | - Shuang Zhang
- Department of Head and Neck Oncology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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