Unusual lung tumours: an illustrated review of CT features suggestive of this diagnosis

Primary pulmonary adenoid cystic carcinoma: A clinicopathological study of 64 patients

BACKGROUND

This study aimed to investigate the clinicopathological features and prognostic indicators of primary pulmonary adenoid cystic carcinoma (PACC).

METHODS

Clinical data were collected from 64 primary PACC patients and analyzed retrospectively at the Tianjin Medical University General Hospital, the West China Hospital of Sichuan University, the First Affiliated Hospital of Guangxi Medical University, and the Bishan Hospital of Chongqing Medical University from January 2003 to August 2023. The 64 patients (28 males and 36 females) were aged from 20 to 73 years, with a median age of 49 years and an average age of 49.3 years.

RESULTS

Immunohistochemical staining showed that the tumors expressed CK7, S-100 protein, CK5/6, CD117, and p63. Seven patients underwent fluorescence in situ hybridization (FISH) testing and three were found to have myeloblastosis (MYB) gene translocation. In total, 53 patients underwent surgery, among whom 31 received only surgery and 22 received both surgery and postoperative chemoradiotherapy. In addition, 10 patients received chemoradiotherapy only, while one patient underwent treatment with traditional Chinese medicine. The overall survival rates in the first, third, and fifth years were 98.4%, 95.3%, and 87.5%, respectively.

CONCLUSION

Prognostic analysis revealed that age, tumor size, lymph node metastasis status, margin status, and choice of treatment modality significantly influenced the patients' prognosis.

Bronchoscopic Management of Endobronchial Atypical Carcinoid With Argon Plasma Coagulation and Laser: A Rare Case With Literature Review

Atypical carcinoid belongs to a spectrum of neuroendocrine tumors that can present as central airway obstruction. We treated a 58-year-old female who presented with recurrent pneumonia. Flexible bronchoscopy showed complete obstruction of the tumor in the right lower lobe. The tumor was excised by electrocautery snare followed by laser and argon plasma coagulation (APC). Endobronchial biopsy showed atypical carcinoid with lymph node metastasis. Succeeding bronchoscopic management, the patient's symptoms improved. In our patient, bronchoscopy with laser and APC was performed to prevent tumor recurrence after resection and reduce the risk of recurrent postobstructive pneumonia. Surveillance computed tomography at six months showed no evidence of recurrence. Bronchoscopic management should be considered in poor surgical candidates or patients with metastatic disease.

Benign Endobronchial Tumors: A Clinicopathologic Review

Purpose: Benign endobronchial tumors are rare entities that can be difficult to diagnose because they often present with non-specific symptoms and vague radiographic findings. The current study reviews the clinical, radiologic and pathologic features, diagnosis, and treatment of patients with benign endobronchial tumors. Methods: We examined the charts of all patients who presented with biopsy-proven benign endobronchial tumors at a tertiary-care academic medical center between 1993 and 2018. Pertinent clinicopathologic and radiologic data were analyzed, with particular attention paid to treatment modalities and mean overall patient survival. Results: A total of 28 cases were identified. The most common benign neoplasm was hamartoma (37%), followed by lipoma (19%), squamous papilloma (11%), pleomorphic adenoma (7%), mucin gland adenoma (7%), papillary adenoma (3%), hemangioma (3%), neurofibroma (3%), leiomyoma (3%), and papillomatosis (3%). Cough (58%), shortness of breath (44%), and hemoptysis (15%) were the most frequent presentations. Most cases demonstrated well-defined submucosal or pedunculated endobronchial lesions with segmental pneumonia or atelectasis on imaging. Histologic diagnosis was obtained by endobronchial resection in 43% of patients, thoracoscopic lobectomy in 36%, endobronchial biopsy in 18%, and thoracoscopic wedge resections in 3%. All procedures were performed with no intraoperative or in-hospital deaths (mean overall survival: 20.2 years). Conclusion: Benign endobronchial tumors typically present as well-defined submucosal and/or pedunculated lesions, and may lead to post-obstructive complications. Endobronchial resection is the preferred strategy for diagnosis and treatment of these tumors.

CT features and differential diagnosis of primary pulmonary mucoepidermoid carcinoma and pulmonary adenoid cystic carcinoma

Background

The differential diagnosis of primary pulmonary mucoepidermoid carcinoma (PMEC) and pulmonary adenoid cystic carcinoma (PACC) is difficult, because both tumors could be similar in terms of certain characteristics on CT.

Methods

The CT findings from 24 cases of PMEC and 30 cases of PACC were retrospectively analyzed. According to the position of the lesion in airway, we divided these cases into three types: central, hilar, and peripheral.

Results

In PMEC, there were 7 cases of central type, 14 cases of hilar type, and 3 cases of peripheral type. And, 57.1% PMEC cases of the hilar type were accompanied by distal bronchial dilatation with mucoid impaction. Patchy areas of low density were observed in 79.2% cases of PMEC. The solid part of most lesions showed moderate (37.5%) or severe enhancement (45.8%). However, in PACC, there were 24 cases of central type, 3 cases of hilar type, and 3 cases of peripheral type. PACC had more cases of central type than PMEC. Moreover, longitudinal extent greater than 3 cm was observed in 62.5% PACC cases of the central type, while infiltration of the luminal perimeter more than 1/2 perimeter was observed in 95.8% PACC cases of the central type. Patchy areas of low density were observed in 26.7% cases of PMEC. In PACC cases, the solid part of 76.7% lesions showed slight enhancement. Cavities could be observed in PMEC, but not in PACC.

Conclusions

PMEC and PACC have different CT features in various airway locations. PMEC is usually the hilar type, accompanied by distal bronchial dilatation with mucoid impaction. However, PACC is usually the central type, with longitudinal extent greater than 3 cm and infiltration of the luminal wall more than 1/2 perimeter. Patchy areas of low density and moderate or severe enhancement are more prominent in PMEC. However, slight enhancement is more common in PACC.

Tracheobronchial tumors

Tumors of trachea and bronchi are uncommon and can occur in the form of benign or low- and high-grade malignant tumors. Although tracheobronchial tumors (TBTs) represent only 0.6% of all pulmonary tumors, they are clinically significant. Delays in diagnosis of these tumors commonly occur because the signs and symptoms caused by these tumors are nonspecific and chest radiographs are often considered unremarkable. Therefore, novel radiological techniques and better access to flexible bronchoscopy enable detection of larger number of TBT. The purpose of this article is to provide a review of tracheal and bronchial tumors and discuss significant aspects of the different TBT with focus on clinical manifestations and diagnostic procedures.

Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of primary pulmonary angiosarcomas

Angiosarcoma is a malignant vascular tumor that originates from the mesenchymal cells which have undergone angioblastic differentiation. Pulmonary angiosarcomas are invariably (>90%) metastatic tumors form primaries of the skin, bone, liver, breast, or heart. Primary pulmonary angiosarcomas are exceedingly rare, with just about 20 cases being reported in the literature. We report an additional case with a brief review of the literature of a primary pulmonary angiosarcoma in a 26-year-old lady who presented with intractable hemoptysis. In addition, we highlight the potential of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography as an important diagnostic tool in the evaluation of this tumor and thus contribute to the existing sparse literature on this fascinating yet devastating disease.

Endobronchial lipomatous polyp: a rare benign tumor of the lung

Endobronchial lipomatous polyp is a rare nonmalignant tumor of the lung. It comprises 5% of the benign lung tumor, with the majority of benign tumors being hamartoma. Lipomatous polyp often leads to endobronchial lesion, associated with postobstructive pneumonia, hemoptysis, and atelectasis. We hereby present a case and discussion of an elderly man with endobronchial lipomatous polyp, presenting as recurrent pneumonia.

Surgical treatment of an endobronchial lipoma obstructing the right upper bronchus: Imaging features with pathological correlation

Endobronchial lipomas are rare benign unusual tumors of the respiratory tract. We describe a 65-year-old Chinese man with a history of cough due to an endobronchial tumor. The endobronchial biopsy was not excisional and was unable to evaluate the whole tumor. Then the mass was successfully resected via a right lateral thoracotomy. The histopathological diagnosis confirmed a benign lipoma arising from the membranous trachea. His CT features and fiberoptic bronchoscopic findings are shown along with the pathological results. In describing the management of this case, we stress that the clinical treatment of such tumors should be individualized according to the characteristics of each patient and mass.

Pulmonary lipoma in a dog

An eight-year-old, neutered, male German short-haired pointer was presented for a chronic cough and an intrathoracic mass. Computed tomography revealed a mass with low attenuation in the right caudal lung lobe that invaded the principal bronchi. The mass was removed by right caudal and accessory lung lobectomy. The histopathological diagnosis was pulmonary lipoma. The clinical signs resolved following surgery. There was no evidence of recurrence or de novo lesions on computed tomography performed 12 months post-surgery. To the authors' knowledge, this is the first report of a pulmonary lipoma in a dog.

Imaging incidental pulmonary nodules

The incidental nodule is an increasingly common clinical conundrum. This article outlines the characteristics that allow differentiation of benign and malignant pathologies and discusses strategies for their follow up and management.

Primary bronchial carcinoid: A rare differential diagnosis of pulmonary koch in young adult patient

Bronchial carcinoids are uncommon, slow growing, low-grade malignant neoplasms comprising 1-2% of all primary lung cancers. They are thought to arise from neuroendocrine/Kulchitsky's cells of bronchial epithelium. Histological features range from low-grade typical to more aggressive atypical carcinoids. Clinically they may be asymptomatic, present with nonresolving recurrent pneumonitis, hemoptysis, or with paraneoplastic syndromes. Central bronchial carcinoids are more common than the peripheral type and are seen as endobronchial nodule or hilar/perihilar mass closely related to the adjacent bronchus. Chest X-ray may not show the central lesion due to its smaller size as is in our case. Contrast-enhanced computerized tomography (CECT) remains a highly sensitive examination which shows an intensely enhancing small rounded endobronchial nodule. We present a case of recurrent pneumonitis and hemoptysis in a young patient who showed features of typical central bronchial carcinoid in CECT and later confirmed with histopathological examination (HPE).

Cavitary pulmonary involvement of diffuse large B-cell lymphoma transformed from extra nodal marginal zone B-cell lymphoma MALT type

We describe a case of pulmonary diffuse large B-cell lymphoma (DLBCL), which was thought to arise from extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). A 68-year-old woman presented with a 2-month history of cough and bloody sputum. The chest X-ray and computed tomography revealed a mass with cavitation in the right lower lobe. Transbronchial biopsy specimens revealed a granulomatous infiltration without malignant cells. However, diagnosis of MALT lymphoma was established from gastric biopsy specimen. Subsequently, a right lower lobectomy was performed because of hemoptysis. Examination of the resected specimen revealed a diffuse large B-cell lymphoma, which was considered to have transformed from MALT lymphoma, because both lung and stomach lesions had the chromosomal translocation t(11;18)(q21;q21) in common. In addition, there were no nodules, masses, alveolar or interstitial infiltrates in the lung fields, which are usually observed in the case of marginal zone B-cell lymphoma of bronchial mucosa-associated lymphoid tissue. These findings indicate that involvement of DLBCL have to be considered in patients with MALT lymphoma and cavitary lesion of the lung.