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Çağan P, Kimiaei A, Safaei S, Youcefi HE, Abu Saadeh A, Yaman F, Yapıcıer Ö, Kutlu CA. Bronchiolar adenoma/ciliated muconodular papillary tumor complicated by lymphoid interstitial pneumonia in a patient with Sjögren's disease: A case report and systematic review. Thorac Cancer 2024; 15:1975-1988. [PMID: 39155148 PMCID: PMC11444930 DOI: 10.1111/1759-7714.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/25/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024] Open
Abstract
Bronchiolar adenoma (BA)/ciliated muconodular papillary tumor (CMPT) is a rare pulmonary neoplasm, with less than 150 cases documented in the literature. We report a unique case of BA/CMPT complicated by lymphoid interstitial pneumonia (LIP) in a 55-year-old male with Sjögren's disease. This is the first documented instance of such a comorbidity. Through a systematic review of PubMed, we also summarize the demographic, clinical, radiological, histopathological, and treatment characteristics of CMPT.
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Affiliation(s)
- Pinar Çağan
- Department of Thoracic SurgeryBahçeşehir UniversityIstanbulTurkey
| | - Ali Kimiaei
- Department of Thoracic SurgeryBahçeşehir UniversityIstanbulTurkey
| | | | | | - Alara Abu Saadeh
- Department of Thoracic SurgeryBahçeşehir UniversityIstanbulTurkey
| | - Feride Yaman
- Department of PulmonologyBahçeşehir UniversityIstanbulTurkey
| | - Özlem Yapıcıer
- Department of PathologyBahçeşehir University School of Medicine, Göztepe Medical Park Training and Education HospitalIstanbulTurkey
| | - Cemal Asim Kutlu
- Department of Thoracic SurgeryBahçeşehir UniversityIstanbulTurkey
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2
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Zhang X, Yuan W, Luo R, Luan L, Huang J, Lu S, Sujie A, Hou Y. Ciliated Muconodular Papillary Tumors of the Lung Harboring STRN::ALK Fusion: Case Report and Review of the Literature. Int J Surg Pathol 2024; 32:1357-1363. [PMID: 38321754 DOI: 10.1177/10668969241226707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Ciliated muconodular papillary tumor (CMPT) is a rare pulmonary tumor, typically occurring in middle-aged and elderly individuals. The molecular mutation spectrum of CMPT remains insufficiently explored. Commonly known driver gene alterations include KRAS, BRAF, EGFR, and ALK rearrangement. This report details the clinicopathological features of 2 patients presenting with CMPT as pulmonary nodules during clinical examinations. Microscopic analysis revealed tumors with glandular or papillary structures, consisting of mucinous cells, ciliated columnar cells, and basal cells. Notably, both patients exhibited STRN::ALK fusion, a finding not previously associated with CMPT. STRN::ALK fusion serves as a target for therapy in various tumors, including non-small cell lung cancer, thyroid cancer, and colon cancer. Consequently, we conducted a review of relevant literature, summarizing the clinicopathological and molecular characteristics of CMPT to facilitate further research. Our insights enhance the understanding of this uncommon tumor and contribute to the expansion of its molecular alteration spectrum.
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Affiliation(s)
- Xinyi Zhang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Yuan
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijuan Luan
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Huang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shaohua Lu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Akesu Sujie
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
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3
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Liu X, Xu Y, Wang G, Ma X, Lin M, Zuo Y, Li W. Bronchiolar adenoma/ciliated muconodular papillary tumour: advancing clinical, pathological, and imaging insights for future perspectives. Clin Radiol 2024; 79:85-93. [PMID: 38049359 DOI: 10.1016/j.crad.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 12/06/2023]
Abstract
Bronchiolar adenoma/ciliated muconodular papillary tumour (BA/CMPT) is a benign peripheral lung tumour composed of bilayered bronchiolar-type epithelium containing a continuous basal cell layer; however, the similarities in imaging and tissue biopsy findings at histopathology between BA/CMPT and malignant tumours, including lung adenocarcinoma, pose significant challenges in accurately diagnosing BA/CMPT preoperatively. This difficulty in differentiation often results in misdiagnosis and unnecessary overtreatment. The objective of this article is to provide a comprehensive and systematic review of BA/CMPT, encompassing its clinical manifestations, pathological basis, imaging features, and differential diagnosis. By enhancing healthcare professionals' understanding of this disease, we aim to improve the accuracy of preoperative BA/CMPT diagnosis. This improvement is crucial for the development of appropriate therapeutic strategies and the overall improvement of patient prognosis.
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Affiliation(s)
- X Liu
- Medical School, Kunming University of Science and Technology, Kunming 650500, P.R. China; Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Y Xu
- Department of Pathology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - G Wang
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - X Ma
- Department of Scientific Research, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - M Lin
- Medical School, Kunming University of Science and Technology, Kunming 650500, P.R. China; Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Y Zuo
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China.
| | - W Li
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China.
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4
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Liao G, Zhang X. Clinicopathological Analysis of Bronchiolar Adenoma Lined Purely by Mucinous Luminal Cells. Case Rep Pathol 2023; 2023:5566499. [PMID: 37942425 PMCID: PMC10630002 DOI: 10.1155/2023/5566499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
Bronchiolar adenoma (BA) is a rare lung tumor that has recently been clearly named, including the previous ciliated muconodular papillary tumor (CMPT) and the so-called nonclassical CMPT. The most prominent histological feature of BA is a double-layer cell structure composed of a continuous basal cell layer and a luminal cell layer. BA lined purely by mucinous luminal cells is very rare, and only one case has been reported in the English literature. This type of BA can easily be misdiagnosed as early mucinous adenocarcinoma. This article analyzes the clinicopathological characteristics of a newly discovered case of BA lined purely by mucinous luminal cells and fully integrated with the literatures.
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Affiliation(s)
- Guangjie Liao
- Department of Pathology, Red Cross Hospital of Yulin, Yulin, China
| | - Xinke Zhang
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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5
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Zheng Q, Hou L, Shang G, Qi X, Zhang M, Jin Y, Wang Y, Xue Q, Wu C, Li Y. Frequent EGFR exon 20 insertion in the so-called peripheral-type squamous cell neoplasm of uncertain malignant potential: a variant of bronchiolar adenoma or under-recognised entity? Histopathology 2023. [PMID: 36864007 DOI: 10.1111/his.14890] [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: 02/20/2023]
Abstract
INTRODUCTION Herein we describe a series of rare peripheral pulmonary neoplasms temporarily termed "peripheral type squamous cell neoplasm of uncertain malignant potential (PSCN-UMP)" and investigate their relationship to bronchiolar adenoma (BA) and squamous cell carcinoma (SCC). MATERIALS AND METHODS The histologic and immunohistochemical features of 10 PSCN-UMPs and six BAs were compared. Whole exome sequencing (WES) and bioinformatics analysis were performed to further compare the genetic features of PSCN-UMPs, BAs, and NSCLCs. RESULTS All PSCN-UMPs were peripherally located and histologically characterised by the lepidic, nested, and papillary proliferation of relatively bland squamous cells, accompanied by entrapped hyperplastic reactive pneumocytes. The basal squamous cells coexpressed TTF1 and squamous markers. Both cellular components exhibited bland morphology and a low proliferative activity. The six BAs met the morphologic and immunophenotypic features of proximal-type BA. Genetically, driver mutations, including frequent EGFR exon 20 insertions, were found in PSCN-UMPs, while the KRAS mutation, BRAF mutation, and ERC1::RET fusion were detected in BAs. PSCN-UMPs also shared some alterations with BAs in mutational signatures, while copy number variants (CNV) were enriched in MET and NKX2-1 in PSCN-UMP and MCL1, MECOM, SGK1, and PRKAR1A in BA. CONCLUSION PSCN-UMPs exhibited the proliferation of bland squamous cells accompanied by entrapped pneumocytes and frequent EGFR exon 20 insertions, which showed distinct features from BAs and SCCs. Recognition of this specific entity will help to expand the morphologic and molecular spectrum of peripheral lung squamous neoplasms.
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Affiliation(s)
- Qiang Zheng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Likun Hou
- Department of Pathology, Tongji University Shanghai Pulmonary Hospital, Shanghai, China
| | - Guoguo Shang
- Department of Pathology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xiaowei Qi
- Department of Pathology, Jiangnan University Affiliated Hospital, Wuxi, China
| | - Mengmeng Zhang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, China
| | - Yan Jin
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Yue Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Qianqian Xue
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Chunyan Wu
- Department of Pathology, Tongji University Shanghai Pulmonary Hospital, Shanghai, China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
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Liu XL, Miao CF, Li M, Li P. Malignant transformation of pulmonary bronchiolar adenoma into mucinous adenocarcinoma: A case report. World J Clin Cases 2023; 11:233-241. [PMID: 36687187 PMCID: PMC9846975 DOI: 10.12998/wjcc.v11.i1.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Bronchiolar adenoma (BA) and ciliated muconodular papillary tumor are rare tumors that have bilayered cell proliferation and continuous expression of p40 and CK5/6 in the basal cell layer. Diagnosis is difficult because of the limited knowledge of these tumors and their morphological similarities to malignant tumors, including invasive mucinous adenocarcinoma, especially based on the histopathology of intraoperative frozen sections. These tumors are now considered to be benign neoplasms, with malignant transformation reported in only a few cases.
CASE SUMMARY A 57-year-old woman presented with a 17.0 mm × 7.0 mm nodule in the lower lobe of the left lung. Hematoxylin-eosin staining and immunohistochemistry of a surgical specimen were performed. The tumor consisted of a BA area and a mucinous adenocarcinoma (MA) area. In the BA area, the tumor had a bilayered structure of luminal cells and basal cells. The basal cells were positive for CK5/6 and p40, but the MA area was negative for these biomarkers. The Ki-67 proliferation index was low (1%-2%). The patient was diagnosed with BA accompanied by MA, and had a favorable outcome.
CONCLUSION The present study indicated that BA may be carcinogenic, and suggests that clinicians should be aware of its potential for malignant transformation.
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Affiliation(s)
- Xu-Ling Liu
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Cheng-Feng Miao
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Min Li
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Peng Li
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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Kishikawa S, Hayashi T, Takamochi K, Takekawa S, Sasahara N, Handa T, Saito T, Suzuki K, Yao T. Comprehensive clinicopathological characteristics and mucin core protein expression profiles of bronchiolar adenoma. Histopathology 2023; 82:264-275. [PMID: 36180978 DOI: 10.1111/his.14806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 12/13/2022]
Abstract
AIMS Bronchiolar adenoma (BA) is a novel entity in the 2021 WHO classification of lung tumours. The expression profile of mucin core proteins in BAs is not clear. The aim of this study was to clarify the expression profiles of mucins and to validate the clinicopathologic and molecular features of BAs. METHODS AND RESULTS We examined the clinicopathological, immunohistochemical, and molecular features of 20 BAs. Our cohort comprised 10 proximal and 10 distal BAs. Only seven of 18 patients (39%) were accurately diagnosed with BA at the time of intraoperative consultation. The frequent genetic alterations were BRAF V600E (35%) and KRAS (30%) mutations, which were mutually exclusive. The expression of MUC1, MUC4, and MUC5B was observed in all cases and that of MUC5AC and MUC6 was observed in nine (45%) and five (25%) cases, respectively. MUC4 was diffusely expressed in 18 cases. In contrast, MUC1, MUC5AC, MUC5B, and MUC6 displayed a patchy expression pattern. These expression patterns were similar to that of bronchiolar epithelium in normal lung tissue. In addition, overexpression of MUC1 and MUC4 on the entire cell surface was not observed in any of the BAs, suggesting their benign nature. CONCLUSION BA commonly exhibits diffuse MUC4 and patchy MUC1 and MUC5B expression. Its unique expression pattern is probably attributed to mucin expression specific to the bronchiolar epithelium. These results confirm the clinicopathologic and molecular characteristics of BA, including the difficulty in intraoperative frozen section diagnosis and the broad morphologic spectrum of BA derived from the bronchiolar epithelium.
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Affiliation(s)
- Satsuki Kishikawa
- Department of Human Pathology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thor, acic Surgery, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Shiori Takekawa
- Department of General Thor, acic Surgery, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Noriko Sasahara
- Department of Human Pathology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takafumi Handa
- Department of Human Pathology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thor, acic Surgery, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takashi Yao
- Department of Human Pathology, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
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8
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Moon J, You S, Sun JS, Park KJ, Koh YW. Ciliated muconodular papillary tumor of the lung with cavitary change: A case report with 11‐year preoperative follow‐up. Thorac Cancer 2022; 13:1866-1869. [PMID: 35491544 PMCID: PMC9200885 DOI: 10.1111/1759-7714.14451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jayoung Moon
- Department of Radiology Ajou University School of Medicine Suwon Republic of Korea
| | - Seulgi You
- Department of Radiology Ajou University School of Medicine Suwon Republic of Korea
| | - Joo Sung Sun
- Department of Radiology Ajou University School of Medicine Suwon Republic of Korea
| | - Kyung Joo Park
- Department of Radiology Ajou University School of Medicine Suwon Republic of Korea
| | - Young Wha Koh
- Department of Pathology Ajou University School of Medicine Suwon Republic of Korea
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9
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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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10
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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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11
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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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12
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Wang Y, Wang D, Wang J, Zhao S, Ren D, Chen G, Wang Q, Xu D, Xu S. Primary ciliated muconodular papillary tumor: A rare pulmonary disease and literature review of 65 cases. Thorac Cancer 2021; 12:1917-1922. [PMID: 33960670 PMCID: PMC8201536 DOI: 10.1111/1759-7714.13963] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 01/28/2023] Open
Abstract
A ciliated muconodular papillary tumor (CMPT) or bronchiolar adenoma (BA) is a rather rare and unique type of lung tumor characterized by tripartite cellular components with a papillary-predominant structure including ciliated columnar cells, mucinous cells, and basal cells. Here, we present the case of a 64-year-old woman who was diagnosed with CMPT in our center. In addition to reporting the clinicopathological characteristics of this case, we also conducted whole exome sequencing (WES) to explore the underlying mechanism. According to current evidence, CMPTs tends to be benign or of low grade malignancy. However, this requires further validation.
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Affiliation(s)
- Yanye Wang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Dan Wang
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Wang
- Department of General Surgery, Tianjin Teda Hospital, Tianjin, China
| | - Shikang Zhao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Dian Ren
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Gang Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiuhui Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Dongbo Xu
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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13
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Nakaguro M, Mino-Kenudson M, Urano M, Ogawa I, Honda Y, Hirai H, Tanigawa M, Sukeda A, Kajiwara N, Ohira T, Ikeda N, Mikami Y, Tada Y, Ikeda JI, Matsubayashi J, Faquin WC, Sadow PM, Nagao T. Sialadenoma Papilliferum of the Bronchus: An Unrecognized Bronchial Counterpart of the Salivary Gland Tumor With Frequent BRAF V600E Mutations. Am J Surg Pathol 2021; 45:662-671. [PMID: 33443864 PMCID: PMC8035241 DOI: 10.1097/pas.0000000000001657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sialadenoma papilliferum (SP) is a rare benign tumor of the salivary glands, and only 3 unequivocal cases of SP arising in the bronchus have been reported. We herein describe the histomorphologic and molecular features of 4 bronchial SP cases and discuss the differential diagnosis of this entity and the relationship with its clinicopathologic mimics, in particular, glandular papilloma and mixed squamous cell and glandular papilloma (GP/MP). We encountered 2 male and 2 female patients with bronchial SP (mean: 66.8 y old). All 4 tumors arose in the central bronchus and were characterized by a combination of surface exophytic endobronchial papillary proliferation and a submucosal multicystic component with complex architecture. The neoplastic epithelium consisted predominantly of nonciliated stratified columnar cells with ciliated, squamous, and mucinous cells present focally. While 2 tumors (50%) harbored a BRAF V600E mutation by molecular and immunohistochemical analysis, similar to GP/MP, no KRAS, HRAS, AKT1, or PIK3CA mutations were detected in any of the cases. Two patients were treated with limited resection, while 2 patients underwent lobectomy based on the diagnosis of adenocarcinoma or possible squamous cell carcinoma in situ in the preoperative biopsy. All survived without recurrence or metastasis for 23 to 122 months after treatment. SP can develop in the central bronchus as the bronchial counterpart of the salivary gland tumor and should be considered in the differential diagnosis of endobronchial tumors. In addition, some histologic resemblance and frequent BRAF V600E mutation raise the possibility of SP and GP/MP being on the same disease spectrum.
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Affiliation(s)
- Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya
University Graduate School of Medicine, Nagoya, Japan
- Department of Pathology, Massachusetts General Hospital and
Harvard Medical School, Boston, Massachusetts
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and
Harvard Medical School, Boston, Massachusetts
| | - Makoto Urano
- Department of Diagnostic Pathology, Fujita Health
University, School of Medicine, Toyoake, Japan
| | - Ikuko Ogawa
- Center of Oral Clinical Examination, Hiroshima University
Hospital, Hiroshima, Japan
| | - Yumi Honda
- Department of Diagnostic Pathology, Kumamoto University
Hospital, Kumamoto, Japan
| | - Hideaki Hirai
- Department of Anatomic Pathology, Tokyo Medical University,
Tokyo, Japan
| | - Maki Tanigawa
- Department of Anatomic Pathology, Tokyo Medical University,
Tokyo, Japan
| | - Aoi Sukeda
- Department of Anatomic Pathology, Tokyo Medical University,
Tokyo, Japan
| | | | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, Tokyo,
Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo,
Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University
Hospital, Kumamoto, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery,
International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Jun-Ichiro Ikeda
- Department of Diagnostic Pathology, Chiba University
Graduate School of Medicine, Chiba, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University,
Tokyo, Japan
| | - William C. Faquin
- Department of Pathology, Massachusetts General Hospital and
Harvard Medical School, Boston, Massachusetts
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital and
Harvard Medical School, Boston, Massachusetts
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University,
Tokyo, Japan
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14
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Kao TH, Yeh YC. Ciliated muconodular papillary tumor/bronchiolar adenoma of the lung. Semin Diagn Pathol 2021; 38:62-71. [PMID: 33985833 DOI: 10.1053/j.semdp.2021.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022]
Abstract
Ciliated muconodular papillary tumor (CMPT) is an uncommon tumor of the lung, usually detected incidentally in the peripheral lung fields on computed tomography. It is most commonly diagnosed in patients between the sixth and last decades of life. The canonical microscopic feature is a tripartite mixture of ciliated columnar, mucous, and basal cells with papillary architecture. However, studies have shown wide morphological variations in this tumor, such as a lack of ciliated columnar or mucous cells and flat instead of papillary architecture. Hence, a new umbrella term, bronchiolar adenoma (BA), has been proposed to encompass all tumors comprising a uniform layer of basal cells underneath the luminal epithelium displaying bronchiolar differentiation. Recent molecular studies on CMPT/BA discovered a high frequency of driver gene alterations, including mutations in the BRAF, EGFR, AKT1, KRAS, and HRAS genes, as well as ALK gene rearrangements. The tumor follows an indolent clinical course, as no recurrences or metastases have been reported in patients who underwent surgical resection. In this article we review the clinical, radiological, and pathological features, and molecular characteristics of CMPTs/BAs.
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Affiliation(s)
- Tzu-Hang Kao
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan.
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15
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Syred K, Morrison I, Weissferdt A. Benign tumours of the bronchopulmonary system. Histopathology 2021; 78:918-931. [PMID: 33629377 DOI: 10.1111/his.14359] [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: 11/29/2022]
Abstract
The vast majority of tumours arising in the bronchopulmonary system are malignant in nature. Benign tumours of the lung are relatively rare and are often incidental findings during clinical investigations for unrelated conditions. These lesions can arise in the bronchial tree or the pulmonary parenchyma and may be of epithelial, mesenchymal, salivary gland-type or unknown differentiation. Although the spectrum of these lesions is wide, the clinical, pathological and immunohistochemical characteristics of the most relevant will be the subject of this review. In addition, the most important features allowing differentiation from malignant pulmonary neoplasms will be discussed.
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Affiliation(s)
- Katherine Syred
- Department of Pathology, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Iain Morrison
- Department of Cellular Pathology, East Surrey Hospital, Redhill, UK
| | - Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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16
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Yang Y, Xie X, Jiang G, Zhang L, Liu H. Clinicopathological characteristic of ciliated muconodular papillary tumour of the lung. J Clin Pathol 2021; 75:128-132. [PMID: 33722842 DOI: 10.1136/jclinpath-2020-207205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022]
Abstract
AIMS Ciliated muconodular papillary tumour (CMPT) is a rare tumour characterised by tripartite cellular components of mucinous cells, ciliated columnar cells and basal cells with a predominantly papillary architecture. Its clinicopathological characteristics and treatment methods have not been fully elucidated. METHODS Twenty-six patients with CMPT diagnosed and treated in our hospital were retrospectively analysed. RESULTS The cohort was composed of 13 males and 13 females, with a mean age of 64.4±5.93 years. The diameter of the primary tumour ranged from 0.3 to 1.4 cm. The lesions appeared as subsolid nodules, ground-glass nodules and cavitary nodules under the CT scan. All the patients underwent surgical treatment and did not receive postoperative adjuvant therapy. All the CMPTs were diagnosed by immunohistochemistry and not by intraoperative frozen sections. Next-generation sequencing detection demonstrated EGFR, KRAS and BRAF mutations and ALK rearrangements in CMPTs. The follow-up duration ranged from 5 to 65 months, and no case of tumour recurrence was observed until the final follow-up. CONCLUSIONS The incidence of CMPT is low, and the prognosis is good. Immunohistochemistry is helpful for an accurate diagnosis of CMPT, while intraoperative frozen sections cannot fully guide the surgical method. Sublobectomy may be enough without adjuvant treatment. CMPTs exhibited a relatively high rate of driver gene mutations, while the mutation sites were not consistent with those in lung adenocarcinoma.
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Affiliation(s)
- Yong Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaofeng Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liping Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongcheng Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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17
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AKT1 Mutations in Peripheral Bronchiolar Papilloma: Glandular Papilloma and Mixed Squamous Cell and Glandular Papilloma Is Distinct From Bronchiolar Adenoma. Am J Surg Pathol 2021; 45:119-126. [PMID: 32868527 DOI: 10.1097/pas.0000000000001573] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Glandular papilloma (GP) and mixed squamous cell and glandular papilloma (MP) are rare benign pulmonary tumors occurring in the bronchi. Bronchiolar adenoma (BA) was recently characterized as a pulmonary tumor exhibiting alveolar spread. Both GP/MP and BA are composed of a mixture of glandular, ciliated, squamous, and basal cells. We aimed to clarify whether GP/MP and BA represent the same tumor. We evaluated the detailed histologic characteristics of 11 cases involving pulmonary peripheral tumors that exhibited histologic features of GP/MP or BA, and performed genetic analyses using targeted panel sequencing, allele-specific polymerase chain reaction, and digital polymerase chain reaction. Histologically, 4 and 7 tumors were classified as GP/MP and BA, respectively. GP/MP showed endobronchiolar papillary growth with a pseudostratified or stratified epithelium. In contrast, 5 BAs showed a predominant flat structure with a bilayered or pseudostratified epithelium, whereas 2 BAs showed a GP/MP-like papillary architecture. The mean epithelial thickness in each tumor was significantly larger in GP/MPs and BAs with a GP/MP-like morphology (103 to 242 μm) than in flat-predominant BA (23 to 47 μm, P=0.0010). AKT1 E17K mutations were detected in all GP/MPs and BAs with GP/MP-like morphology but were absent in the 5 flat-predominant BAs. AKT1 mutations were always concurrent with BRAF or HRAS mutations, and the variant allele frequency or percentage of mutant copies of AKT1 mutations was equal to those of BRAF or HRAS mutations. GP/MPs are characterized by AKT1 mutations concurrent with BRAF or HRAS mutations. Peribronchiolar papillary tumors with AKT1 mutations may also be classified as GP/MP.
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18
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Matsushima R, Mori T, Saeki S, Hinokuma H, Tanaka H, Yokomizo H. Long-term follow-up of ciliated muconodular papillary tumor of the lung by computed tomography: a case report. J Surg Case Rep 2020; 2020:rjaa522. [PMID: 33391650 PMCID: PMC7769221 DOI: 10.1093/jscr/rjaa522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/19/2020] [Indexed: 01/14/2023] Open
Abstract
Ciliated muconodular papillary tumor (CMPT) is an extremely rare pulmonary tumor and the clinical characteristics are still unknown. We report the preoperative long-term clinical course and changes in computed tomography (CT) findings of CMPT. A 60-year-old man underwent lower bilobectomy for squamous cell carcinoma in the right lower lobe 18 years before the surgery for CMPT. Twelve years before the surgery for CMPT, a 4-mm small ground glass nodule arose in the left lower lobe. The nodule gradually grew and became dense over time. Because it became mostly solid with central cavities, the patient underwent wedge resection and the tumor was diagnosed as CMPT. There were no recurrences 20 months after surgery. The preoperative CT findings of CMPT were similar to progressive preinvasive lesion, whereas it followed the benign clinical course. To the best of our knowledge, this is the first report on long-term preoperative follow-up of CMPT.
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Affiliation(s)
- Ryohei Matsushima
- Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
| | - Takeshi Mori
- Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
| | - Sho Saeki
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hironori Hinokuma
- Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
| | - Hidekazu Tanaka
- Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto 861-8520, Japan
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19
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Yang X, Hou Y, Geng J, Geng J, Meng H. Ciliated Muconodular Papillary Tumors of the Lung: Distinct Molecular Features of an Insidious Tumor. Front Genet 2020; 11:579737. [PMID: 33133167 PMCID: PMC7550676 DOI: 10.3389/fgene.2020.579737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/09/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Ciliated muconodular papillary tumors (CMPTs) are rare special peripheral pulmonary nodule composed of different cell proportions, characterized by papillary structures and significant alveolar mucus. Because of their rarity, underrecognized processes, the full range clinical course and histogenesis of CMPTs remains uncertain. Methods Molecular features of 5 CMPTs cases (one case with mucinous adenocarcinoma simultaneously) were observed by whole exon gene detection. The histological features of CMPTs and the development trends of three major constituent cells were studied by immunohistochemistry and PCR. Results NGS revealed 77 gene mutations in the patient's tumor tissue and 31 mutations in the border tissue. TMB of CMPT tends to TMB of cancer tissues, and both are higher than normal tissues, CMPT share the same phylogenetic tree with cancer tissues. Moreover, PDL1, B7H3, and B7H4 were overexpressed in high columnar cells and eosinophilic ciliated cells of CMPT, tends to cancer tissues, while LAG3 and siglec15 were not found in CMPT. Conclusion The high prevalence of driver gene mutations in CMPTs, similar TMB and phylogenetic tree with cancer tissues indicate their malignant potential. Distinct molecular and immune check point features of each component support the notion that ciliated columnar cells in CMPT are insidious with immune escape.
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Affiliation(s)
- Xinxin Yang
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yunjing Hou
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiashi Geng
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jingshu Geng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hongxue Meng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
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20
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Liu S, Liu N, Xiao M, Wang L, Wang EH. First case of bronchiolar adenoma lined purely by mucinous luminal cells with molecular analysis: A case report. Medicine (Baltimore) 2020; 99:e22322. [PMID: 32991441 PMCID: PMC7523813 DOI: 10.1097/md.0000000000022322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Bronchiolar adenoma (BA) is a newly designated rare entity of the lung, including both the currently designated ciliated muconodular papillary tumor (CMPT) and so-called non-classic CMPT. The most prominent histological feature of BAs is the bilayered cell structures composed of the continuous basal cell layer and the luminal layer which consists of different proportion of mucinous cells, ciliated cells, Clara cells and/or type II pneumocytes. BA purely covered by mucinous cells without other components in the luminal layer has never been reported. PATIENT CONCERNS An 82-year-old female patient was detected a 0.8 cm ground glass nodule in the left lower lobe of the lung. DIAGNOSES The serum levels of tumor markers were normal. INTERVENTIONS The patient underwent a segmentectomy of the left lower lobe. OUTCOMES The postoperative pathological diagnosis was BA. Molecular analysis revealed that the tumor harbored ALK rearrangement and BRAF mutations simultaneously. There was no recurrence in 17 months of follow-up. LESSONS BA can be lined only by mucinous cells, without any cuboidal and/or ciliated cells in the surface layer. This sets a dangerous pitfall in differentiation diagnosis with invasive mucinous adenocarcinoma especially during intraoperative frozen pathological diagnosis.
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Affiliation(s)
- Shuli Liu
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Nan Liu
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Mingming Xiao
- Department of Pathology, the People's Hospital of Liaoning Province, Shenyang, China
| | - Liang Wang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - En-Hua Wang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
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21
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Sun Y, Liu M, Jiang Z, Li B. Bronchiolar adenoma with diffuse pulmonary nodules: a extremely rare case report and review of literature. BMC Pulm Med 2020; 20:192. [PMID: 32664852 PMCID: PMC7362490 DOI: 10.1186/s12890-020-01228-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Bronchiolar adenoma(BA) is a recently recognized, rare tumor of the bronchioles. It can be divided into proximal and distal types according to the proportion of mucinous and ciliated cells on the luminal surface. BA is often misdiagnosed because it has similar ultrasonographic, gross and histological presentations as other diseases. Here, we report a rare case of BA characterized by many fused nodules. Case presentation A 68-year-old woman attended the Tianjin Taida Hospital surgical Clinic mainly because of “intermittent cough for >1 month”. Chest computed tomography (CT) showed multiple solid nodules in the upper and lower left lung. The nodules had irregular outlines, with a maximum diameter of 65 mm. A double needle lung biopsy specimen was removed guided by ultrasound under local anesthesia. Histologically, the biopsy specimen was finally diagnosed as the distal type of BA. Conclusion BA with diffuse pulmonary nodules is rare. Diagnosis of BA needs comprehensive analysis of imaging, gross specimen analysis, histopathology, and immunohistochemical staining to make a correct diagnosis and avoid misdiagnosis. There are few studies on prognosis, which needs close follow-up and more data accumulation.
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Affiliation(s)
- Yajing Sun
- Department of Pathology, Tianjin Fifth Central Hospital, 41 Zhejiang Road, Tanggu District, Tianjin, 300450, China.
| | - Min Liu
- Department of Pathology, Tianjin Fifth Central Hospital, 41 Zhejiang Road, Tanggu District, Tianjin, 300450, China
| | - Zhongmin Jiang
- Department of Pathology, Tianjin Fifth Central Hospital, 41 Zhejiang Road, Tanggu District, Tianjin, 300450, China
| | - Baojiang Li
- Department of Pathology, Tianjin Fifth Central Hospital, 41 Zhejiang Road, Tanggu District, Tianjin, 300450, China
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22
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Lin DL, Xing XM, Ran WW, Zhao H, Li GQ, Xu J, Wang Y, Shao SH, Wang JG. Pulmonary peripheral glandular papilloma and mixed squamous cell and glandular papilloma frequently harbour the BRAF V600E mutation. Histopathology 2020; 76:997-1004. [PMID: 32096885 DOI: 10.1111/his.14098] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 12/16/2022]
Abstract
AIMS Pulmonary peripheral glandular papilloma (GP) and mixed squamous cell and glandular papilloma (MP) have very similar histological features to pulmonary ciliated muconodular papillary tumour (CMPT)/bronchiolar adenoma (BA). The underlying genetic relationships between GP/MP and CMPT/BA have rarely been characterised. We aimed to reveal the relationship between them. METHODS AND RESULTS We performed a clinicopathological review and next-generation sequencing (NGS) study of two GPs and five MPs. Histologically, GPs/MPs showed similar cellular and architectural features to CMPTs/BAs, such as bilayered epithelium, bronchiole-associated lesions and skipping (discontinuous) growth pattern. One MP showed partial and inconspicuous endobronchiolar growth and more glandular structures, which was very similar to the appearance of CMPT/BA. BRAF V600E mutation was detected in four papillomas (57.1%, one GP and three MPs). CONCLUSIONS Overlapping morphological features and comparable mutation profiles support that peripheral GPs/MPs and CMPTs/BAs are on the same disease spectrum. We propose expanding the concept of CMPT/BA and including GP and MP in the CMPT/BA family.
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Affiliation(s)
- Dong-Liang Lin
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao-Ming Xing
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wen-Wen Ran
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Han Zhao
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guang-Qi Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jin Xu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shi-Hong Shao
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ji-Gang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
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23
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Ciliated Muconodular Papillary Tumor of the Lung: Thin-Section CT Findings of 16 Cases. AJR Am J Roentgenol 2020; 214:761-765. [PMID: 31967497 DOI: 10.2214/ajr.19.21945] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The purpose of this article was to assess thin-section CT features of ciliated muconodular papillary tumors (CMPTs) of the lung and correlations between radiologic and pathologic findings. MATERIALS AND METHODS. Thin-section CT findings of 16 patients (10 men and six women; mean age, 70.7 years) with surgically resected CMPTs were retrospectively analyzed. Size, location, and internal characteristics of the tumors were evaluated. The amount of mucin in the tumors was assessed histopathologically and compared with CT findings. Tumor growth speed was calculated on the basis of size changes on thin-section CT. RESULTS. In all 16 patients, tumors were detected as a solitary pulmonary nodule. Thirteen tumors (81.3%) were located in the lower lobes, and 10 (62.5%) were adjacent to the pleura. Mean maximal diameter of the tumors was 9.1 mm (range, 6-14 mm). One tumor (6.3%) presented as a pure ground-glass nodule (GGN), seven (43.8%) as dense GGNs, and eight (50.0%) as solid nodules. Pathologically, the pure GGN and five of seven dense GGNs had a large amount of mucin, whereas seven of eight solid nodules had an intermediate or small amount of mucin. The mean annual tumor growth rate (in diameter) was 0.49 mm/y. CONCLUSION. CMPTs appear as solitary, small, and peripheral pulmonary nodules with very slow growth rates. CMPTs appearing as pure GGNs and dense GGNs tend to contain more mucin than CMPTs appearing as solid nodules.
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24
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Ciliated muconodular papillary tumor of the lung: a case report and literature review. Gen Thorac Cardiovasc Surg 2019; 68:1344-1349. [DOI: 10.1007/s11748-019-01252-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/10/2019] [Indexed: 12/14/2022]
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25
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Chu L, Ni J, Yang X, Tong T, Wang J, Yin F, Li R, Li Y, Zou L, Li Y, Xie C, Li G, Zhu Z. Radiographic Features of Metastatic Brain Tumors from ALK-rearranged Non-small Cell Lung Cancer: Implications for Optimal Treatment Modalities. J Cancer 2019; 10:6660-6665. [PMID: 31777594 PMCID: PMC6856904 DOI: 10.7150/jca.30091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 08/31/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose: To investigate the radiological features on magnetic resonance imaging (MRI) of brain metastases (BM) from ALK-rearranged non-small cell lung cancer (NSCLC). Patients and Methods: We retrospectively evaluated data from 40 eligible patients with ALK-rearranged NSCLC. Radiographic features of metastatic brain tumors, including the number, size, location, and peritumoral brain edema size (PBES), were delineated using MRI. Results: 13 patients had metachronous BM (MBM), having developed BM at least 6 months after diagnosis with NSCLC. The remaining patients were categorized as having synchronous BM (SBM). Compared with patients in the SBM group, patients in the MBM group were found to have more favorable values for radiological features including BM number, BM size, and PBES. Ten (76.9%) of the 13 patients with MBM had ≤3 lesions and were asymptomatic, and none had developed a diffuse BM pattern, supporting the adoption of stereotactic radiosurgery (SRS) in the majority of these patients and against the administration of prophylactic cranial irradiation (PCI). Conversely, among the 27 patients with SBM, 15 (55.6%) patients had >3 lesions and 12 (44.4%) patients were symptomatic, highlighting the necessity of rapidly administrating brain radiotherapy, either as SRS or whole brain radiotherapy (WBRT). Importantly, only two patients (5.0%) had metastases in the hippocampus and peri-hippocampus region, and both were in the SBM group, indicating the feasibility of hippocampal avoidance WBRT in ALK-rearranged NSCLC. Conclusions: Both WBRT and SRS are appropriate for the treatment of BM in patients with ALK-rearranged NSCLC. The incidence of BM in the hippocampus and peri-hippocampus region is low in our radiological data. Nearly 80% of patients with metachronous BM have oligo-metastatic lesions, indicating that SRS is the preferred therapy while PCI is not indicated.
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Affiliation(s)
- Li Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jialei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Fang Yin
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Ruimin Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yida Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Liqing Zou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Congying Xie
- Radiotherapy and Chemotherapy Department, the 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guodong Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Shao K, Wang Y, Xue Q, Mu J, Gao Y, Wang Y, Wang B, Zhou L, Gao S. Clinicopathological features and prognosis of ciliated muconodular papillary tumor. J Cardiothorac Surg 2019; 14:143. [PMID: 31340823 PMCID: PMC6651997 DOI: 10.1186/s13019-019-0962-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUNDS The pulmonary ciliated muconodular papillary tumor (CMPT) is a very rare tumor with only several case reports in published literatures, and its clinicopathological features, standard treatment methods and prognosis has not been well defined. METHODS Two cases of CMPT diagnosed and treated in our hospital and 39 cases reported in the published literature were analyzed retrospectively. RESULTS The cohort of 41 CMPT patients comprised of 20 males and 21 females, aged 9-84 years. The diameter of the primary tumor was 0.3-4.5 cm. Most of these lesions were subsolid nodules, as observed on computed tomography and easily misdiagnosed as early lung adenocarcinoma. Tumors of 26 patients were stained by immunohistochemistry method, which revealed that CK7, CEA, and TTF-1 were positive and CK20 was negative in most patients. The results of gene alternation demonstrated mutations in EGFR, KRAS, and BRAF and ALK rearrangements in CMPT. All the patients underwent surgical treatment and did not receive postoperative adjuvant therapy. The follow-up duration was 0-120 months, and no case of tumor recurrence was found until the final follow-up. CONCLUSIONS The incidence of CMPT was low and rate of image misdiagnosis high. Immunohistochemistry is helpful for accurate diagnosis of CMPT. Sub-lobectomy may be proper and adjuvant treatment should be avoided since the disease is now prone to benign lesions. Furthermore, since the biological behavior of this tumor is not yet fully elucidated, additional case data are essential for accurate conclusions.
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Affiliation(s)
- Kang Shao
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Yalong Wang
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Yonggang Wang
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Lina Zhou
- Department of Diagnostic Radiology, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
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Bronchiolar Adenoma: Expansion of the Concept of Ciliated Muconodular Papillary Tumors With Proposal for Revised Terminology Based on Morphologic, Immunophenotypic, and Genomic Analysis of 25 Cases. Am J Surg Pathol 2019; 42:1010-1026. [PMID: 29846186 DOI: 10.1097/pas.0000000000001086] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We have identified 25 lesions involving alveolar lung parenchyma characterized by nodular proliferation of bland bilayered bronchiolar-type epithelium containing a continuous layer of basal cells. These lesions shared some histologic features with the recently described entity of ciliated muconodular papillary tumor (CMPT); however, the majority did not fit all diagnostic criteria in that they exhibited only focal or absent papillary architecture, and they had variable number of ciliated and mucinous cells, with some lesions entirely lacking 1 or both of these components. The morphologic and immunohistochemical features ranged from those resembling proximal bronchioles (proximal-type: moderate to abundant mucinous and ciliated cells; negative or weak TTF1 in luminal cells; n=8) to those resembling respiratory bronchioles (distal-type: scant or absent mucinous and ciliated cells; positive TTF1 in luminal cells; n=17). The hallmark of all lesions was a continuous layer of basal cells (p40 and CK5/6-positive). We provisionally designated these lesions as bronchiolar adenomas (BAs) and analyzed their clinicopathologic and molecular features. All BAs were discrete, sharply circumscribed lesions with a median size of 0.5 cm (range, 0.2 to 2.0 cm). Most lesions were either entirely flat (n=14) or contained focal papillary architecture (n=7); only 4 lesions, all proximal-type, were predominantly papillary, fitting the classic description of CMPT. Notably, of 9 lesions submitted for frozen section evaluation, 7 were diagnosed as adenocarcinoma. No postsurgical recurrences were observed for any lesions (median follow-up, 11 mo). Twenty-one BAs underwent next-generation sequencing and/or immunohistochemistry for BRAF V600E, revealing mutation profiles similar to those previously described for CMPTs, including BRAF V600E mutations (n=8, 38%), unusual EGFR exon 19 deletions (n=2, 10%), EGFR exon 20 insertions (n=2, 10%), KRAS mutations (n=5, 24%), and HRAS mutations (n=1, 5%). The mutation profiles were similar in proximal-type and distal-type lesions. In conclusion, we describe a family of putatively benign clonal proliferations with a spectrum of morphology recapitulating various levels of the bronchiolar tree, of which only a minor subset fits the classic description of CMPT. Comparable mutation profiles and partially overlapping morphologic features across the spectrum of these lesions support their nosological relationship. We propose designating this entire family of lesions as BAs, and that lesions currently designated CMPTs represent a subgroup of this family.
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28
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Mikubo M, Maruyama R, Kakinuma H, Yoshida T, Satoh Y. Ciliated muconodular papillary tumors of the lung: Cytologic features and diagnostic pitfalls in intraoperative examinations. Diagn Cytopathol 2019; 47:716-719. [DOI: 10.1002/dc.24169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Masashi Mikubo
- Department of Thoracic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Raito Maruyama
- Department of Thoracic Surgery; Kitasato University School of Medicine; Kanagawa Japan
| | - Hirokuni Kakinuma
- Department of Pathology; Kitasato University Hospital; Kanagawa Japan
| | - Tsutomu Yoshida
- Department of Pathology; Kitasato University Hospital; Kanagawa Japan
| | - Yukitoshi Satoh
- Department of Thoracic Surgery; Kitasato University School of Medicine; Kanagawa Japan
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29
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Kashima J, Hishima T, Tonooka A, Horiguchi SI, Motoi T, Okuma Y, Hosimi Y, Horio H. Genetic and immunohistochemical analyses of ciliated muconodular papillary tumors of the lung: A report of five cases. SAGE Open Med Case Rep 2019; 7:2050313X19830483. [PMID: 30800314 PMCID: PMC6378433 DOI: 10.1177/2050313x19830483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/22/2019] [Indexed: 12/21/2022] Open
Abstract
Ciliated muconodular papillary tumors are benign lesions located in the peripheral lung field. Recent studies revealed BRAF and epidermal growth factor receptor gene mutations and anaplastic lymphoma kinase gene rearrangement. Five ciliated muconodular papillary tumors were screened for the BRAF V600E and EGFR mutations via polymerase chain reaction. Immunohistochemical analysis was performed for the detection of the BRAF V600E and anaplastic lymphoma kinase proteins, as well as other markers including phosphorylated extracellular signal-regulated protein kinase. Three tumors (60%) harbored the BRAF V600E mutation. Immunohistochemical analysis confirmed this mutation in all of the tumor cell types. EGFR mutation and immunoactivity of the anaplastic lymphoma kinase protein were not detected. Phosphorylated extracellular signal-regulated protein kinase was negative both in the cytoplasm and nucleus of the BRAF V600E-positive tumors. Mucin 1, mucin 4, thyroid transcription factor 1, and cytokeratin 7 were positive, and mucin 5AC was partially positive, whereas napsin A and cytokeratin 20 were negative. Ciliated muconodular papillary tumor may originate from the terminal bronchioles, and the status of ERK activation reflects its benign behavior.
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Affiliation(s)
- Jumpei Kashima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Akiko Tonooka
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Shin-Ichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Toru Motoi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yukio Hosimi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Hirotoshi Horio
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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30
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Abstract
Ciliated muconodular papillary tumor is a rare tumor of the lung with 38 cases reported to date in the English literature. It is typically found incidentally in older adults (average age, 67 years) as a small, peripheral, ground glass opacity or nodule on computed tomography. Microscopically, the tumor is composed of a mixture of ciliated columnar, mucous, and basal cells in a variety of architectural patterns including glandular, papillary, lepidic, and micropapillary growth patterns. Recently, studies have shown the tumor has several associated gene alterations, supporting that the lesion is indeed neoplastic. The tumor seemingly follows an indolent clinical course, as there have been no reported recurrences or metastases. In this article, we review the clinical, radiographic, pathologic, and molecular findings of ciliated muconodular papillary tumors. Diagnostic pitfalls and the diagnostic considerations are discussed.
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Affiliation(s)
- Yen-Wen Lu
- From the Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chen Yeh
- From the Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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31
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So-called "non-classic" ciliated muconodular papillary tumors: a comprehensive comparison of the clinicopathological and molecular features with classic ciliated muconodular papillary tumors. Hum Pathol 2018; 82:193-201. [PMID: 30092236 DOI: 10.1016/j.humpath.2018.07.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 12/17/2022]
Abstract
Ciliated muconodular papillary tumors (CMPTs) are characterized by tripartite cellular components of ciliated columnar cells, mucinous cells, and basal cells with predominantly papillary architecture. Some peripheral lung nodules may not demonstrate papillary architecture and tripartite cells that show bronchiolar differentiation; these nodules are termed "CMPTs with non-classic morphology" by some authors. To validate the rationality of "non-classic" CMPTs and to analyze the clinicopathological features of CMPTs, we enrolled 21 cases of lung nodules, comprising classic CMPTs (n = 11) and so-called non-classic CMPTs (n = 10). The status of driver mutations, including those in EGFR, BRAF, ALK, and KRAS, was examined by molecular tests. Clinical and radiological follow-up was performed (3-27 months). Cilia as well as the mucinous and papillary components are usually present throughout classic CMPTs but may be absent in their non-classic counterparts. However, both entities present a bi-layer architecture with evidence of bronchiolar differentiation. Driver mutations involved the BRAF (n = 6), EGFR (n = 1) and ALK (n = 1), were identified in 8 of 11 (73%) classic CMPTs, whereas driver mutations, comprising BRAF (n = 2), EGFR (n = 1) and KRAS (n = 1), were identified in 4 of 10 (40%) non-classic lesions. Since it contains the largest series of Chinese patients with CMPTs, this study may expand the morphologic and molecular spectrum of CMPTs: a hallmark of CMPTs is bi-layer architecture with a continuous basal layer that can harbor high-frequency driver mutations. Recognition of the non-classic morphology of CMPTs may be helpful to avoid misdiagnosis and unnecessary treatment.
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32
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Miyai K, Takeo H, Nakayama T, Obara K, Aida S, Sato K, Matsukuma S. Invasive form of ciliated muconodular papillary tumor of the lung: A case report and review of the literature. Pathol Int 2018; 68:530-535. [DOI: 10.1111/pin.12708] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/06/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Kosuke Miyai
- Department of Pathology; Japan Self-Defense Forces Central Hospital; Tokyo Japan
| | - Hiroaki Takeo
- Department of Pathology; Japan Self-Defense Forces Central Hospital; Tokyo Japan
| | - Takefumi Nakayama
- Thoracic Surgery; Japan Self-Defense Forces Central Hospital; Tokyo Japan
| | - Kiyohaya Obara
- Thoracic Surgery; Japan Self-Defense Forces Central Hospital; Tokyo Japan
| | - Shinsuke Aida
- Department of Pathology; Mita Hospital; International University of Health and Welfare; Tokyo Japan
| | - Kimiya Sato
- Department of Basic Pathology; National Defense Medical College; Saitama Japan
| | - Susumu Matsukuma
- Department of Pathology; Japan Self-Defense Forces Central Hospital; Tokyo Japan
- Health Care Center; Japan Self-Defense Forces Central Hospital; Tokyo Japan
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33
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Yabuki K, Matsuyama A, Obara K, Takenaka M, Tanaka F, Nakatani Y, Hisaoka M. A unique case of a huge mixed squamous cell and glandular papilloma of non-endobronchial origin with a peripheral growth. Respir Med Case Rep 2018; 24:108-112. [PMID: 29977775 PMCID: PMC6010628 DOI: 10.1016/j.rmcr.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/02/2018] [Indexed: 12/21/2022] Open
Abstract
We report a case of a huge solitary non-endobronchial pulmonary tumor in a 76-year-old male smoker. The tumor measured 11 × 10 × 8 cm. It was ill-defined, and it was located periphery of the right lower lobe with the subpleural cystic spaces. He underwent right lower lobectomy with mediastinal lymph node dissection and is free from tumor 30 months after surgery. Microscopically, it was composed of a proliferation of squamous and ciliated columnar epithelial cells with a few mucous cells. These cells were arranged in a papillary growth fashion extending along the fibrously thickened alveolar septa together with metaplastic bronchiolar and squamous epithelia displaying an usual interstitial pneumonia-pattern. Although the histologic features of the tumor were that of a mixed squamous cell and glandular papilloma (MSCGP), it was peripherally located and showed a lepidic growth, and it was much larger than previously reported MSCGPs. It is possible that the tumor developed in association with bronchial metaplasia in the periphery of the lung, and then extended along the surface of the reconstructed air spaces, which resulted in its unique histologic appearance. Further investigations of respiratory papilloma are needed to clarify the pathogenesis of these lesions.
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Affiliation(s)
- Kei Yabuki
- Departments of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Atsuji Matsuyama
- Departments of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Kosho Obara
- Department of Surgical Pathology, University Hospital of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Masaru Takenaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Masanori Hisaoka
- Departments of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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34
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Kitawaki Y, Fujishima F, Taniuchi S, Saito R, Nakamura Y, Sato R, Aoyama Y, Onodera Y, Inoshita N, Matsuda Y, Watanabe M, Sasano H. Coexistence of glandular papilloma and sclerosing pneumocytoma in the bronchiole. Pathol Int 2018; 68:425-430. [DOI: 10.1111/pin.12677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/02/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Yuko Kitawaki
- Department of Anatomic Pathology; Tohoku University Graduate School of Medicine
| | | | | | - Ryoko Saito
- Department of Anatomic Pathology; Tohoku University Graduate School of Medicine
| | - Yasuhiro Nakamura
- Division of Pathology; Faculty of Medicine; Tohoku Medical and Pharmaceutical University; Sendai
| | - Ryoko Sato
- Division of Pathology; Tohoku University Hospital
| | - Yayoi Aoyama
- Division of Pathology; Tohoku University Hospital
| | | | | | | | - Mika Watanabe
- Research Division for Development of Anti-Infective Agents; Institute of Development, Aging and Cancer; Tohoku University; Sendai Japan
| | - Hironobu Sasano
- Department of Anatomic Pathology; Tohoku University Graduate School of Medicine
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35
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Kataoka T, Okudela K, Matsumura M, Mitsui H, Suzuki T, Koike C, Sawazumi T, Umeda S, Tateishi Y, Yamanaka S, Ishikawa Y, Arai H, Tajiri M, Ohashi K. A molecular pathological study of four cases of ciliated muconodular papillary tumors of the lung. Pathol Int 2018; 68:353-358. [DOI: 10.1111/pin.12664] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/24/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Toshiaki Kataoka
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Koji Okudela
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Mai Matsumura
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Hideaki Mitsui
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Takehisa Suzuki
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Chihiro Koike
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Tomoe Sawazumi
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Shigeaki Umeda
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Yoko Tateishi
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Shoji Yamanaka
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Yoshihiro Ishikawa
- Department of Surgery; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Hiromasa Arai
- Division of General Thoracic Surgery; Kanagawa Prefectural Cardiovascular and Respiratory Center Hospital; Yokohama Japan
| | - Michihiko Tajiri
- Division of General Thoracic Surgery; Kanagawa Prefectural Cardiovascular and Respiratory Center Hospital; Yokohama Japan
| | - Kenichi Ohashi
- Department of Pathology; Yokohama City University Graduate School of Medicine; Yokohama Japan
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36
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Udo E, Furusato B, Sakai K, Prentice LM, Tanaka T, Kitamura Y, Tsuchiya T, Yamasaki N, Nagayasu T, Nishio K, Fukuoka J. Ciliated muconodular papillary tumors of the lung with KRAS/BRAF/AKT1 mutation. Diagn Pathol 2017; 12:62. [PMID: 28830562 PMCID: PMC5568349 DOI: 10.1186/s13000-017-0651-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/24/2017] [Indexed: 12/21/2022] Open
Abstract
Background Ciliated muconodular papillary tumors (CMPTs) are newly recognized rare peripheral lung nodules that are histologically characterized by ciliated columnar, goblet, and basal cells. Although recent studies have shown that CMPTs constitute a neoplastic disease, the complete histogenesis of CMPTs is not fully understood and molecular data are limited. Methods We reviewed four cases of CMPT and performed immunohistochemical and genomic analyses to establish CMPT profiles. Results All cases were positive for hepatocyte nuclear factor-4α and mucin 5B and negative for programmed death ligand 1 expression, as determined by immunohistochemistry. The genetic analysis revealed three pathogenic mutations (BRAF V600E, AKT1 E17K, and KRAS G12D), with the KRAS mutation reported here for the first time. Conclusion Histological and genetic profiles indicate that CMPTs are likely neoplastic and exhibit features similar to mucinous adenocarcinoma. This suggests that some CMPTs may be a precursor lesion of mucinous adenocarcinoma. Electronic supplementary material The online version of this article (doi:10.1186/s13000-017-0651-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emiko Udo
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Bungo Furusato
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Kazuko Sakai
- Department of Genome Biology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Leah M Prentice
- Contextual Genomics, Suite #204 Donald Rix Building 2389 Health Sciences Mall, Vancouver, V6T 1Z3, BC, Canada
| | - Tomonori Tanaka
- Department of Genome Biology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yuka Kitamura
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Naoya Yamasaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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