1
|
Yang L, Tomashefski JF, Keskin T, Santoscoy TG, Abramovich C. Endobronchial Glandular Papilloma With Atypical Histologic Characteristics: A Case Report and Literature Review. Int J Surg Pathol 2024; 32:632-640. [PMID: 37488137 DOI: 10.1177/10668969231188420] [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: 07/26/2023]
Abstract
Papilloma of the lung is a rare benign entity and can be solitary or multiple. Solitary papilloma is subclassified into three categories: squamous papilloma, glandular papilloma, and mixed squamous and glandular papilloma. Glandular papilloma is the rarest subtype among them and occurs mostly in the sixth decade without any relation to smoking, syndrome, or infection. Histology is characterized by mixture of pseudostratified, columnar, nonciliated, mucinous epithelium-lined papillary fronds without any mitoses, necrosis, or atypia. The differential diagnosis can be broad depending upon the histologic features present in a particular case and may include both benign and malignant entities. We present here a patient with glandular endobronchial papilloma showing unusual clinical history and atypical histologic features, which required extensive immunohistochemical evaluation to establish a final diagnosis.
Collapse
Affiliation(s)
- Linlin Yang
- Department of Pathology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - Joseph F Tomashefski
- Department of Pathology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| | - Taha Keskin
- Department of Pathology, Cooperman Barnabas Medical Center, Livingston, NJ, USA
| | - Thomas G Santoscoy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Caroline Abramovich
- Department of Pathology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA
| |
Collapse
|
2
|
Boland JM. What's new in benign lung tumours? Histopathology 2024; 84:124-135. [PMID: 37691383 DOI: 10.1111/his.15037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
While lung cancer is one of the most common malignancies routinely encountered by pathologists, benign pulmonary neoplasms are quite rare. However, it is important for pathologists to be familiar with the typical diagnostic features of benign lung tumors to avoid confusing them with malignant morphological mimics. There have also been intriguing discoveries in the genetics of benign pulmonary neoplasms in the past decade. This review will cover several of the most common benign lung tumors, including the diagnostic categories of pulmonary adenomas, bronchial papillomas, and benign mesenchymal tumors, with discussion of the current classification, differential diagnosis, and current knowledge regarding genetic drivers.
Collapse
|
3
|
Sasaki E, Masago K, Kogure Y, Fujita S, Iwakoshi A, Kuroda H, Tsuzuki T, Tsuta K, Matsushita H, Oki M. Mucous Gland Adenoma of the Lung: A Neoplastic Counterpart of Mucinous Bronchial Glands. Mod Pathol 2023; 36:100182. [PMID: 37028599 DOI: 10.1016/j.modpat.2023.100182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
Mucous gland adenoma (MGA) is a rare benign tumor that usually arises in the proximal airway and consists of mucus-secreting cells resembling bronchial glands. Here, we report 2 cases of MGAs and describe their morphologic, immunohistochemical, and molecular profiles in comparison with 19 pulmonary tumors of 5 other histologic types with mucinous cells (invasive mucinous adenocarcinoma, mucoepidermoid carcinoma, mixed squamous cell and glandular papilloma, bronchiolar adenoma/ciliated muconodular papillary tumor, and sialadenoma papilliferum). Two MGAs were found in 1 male patient and 1 female patient, located in the bronchus and trachea, respectively. One MGA was examined by RNA sequencing, and no putative driver mutations (including BRAF, KRAS, and AKT1 mutations) or gene fusions were identified. In another case of MGA, V600E mutations of BRAF and E17K mutations of AKT1 were not detected by allele-specific real-time PCR or digital PCR, respectively. However, a gene expression analysis revealed that the MGA presented a specific RNA expression profile with multiple genes enriched in the salivary gland. The gene expression of NKX3.1 was significantly higher in the MGA case in comparison to normal control lungs (P < .001). We then examined NKX3.1 immunohistochemistry for 2 MGAs and 19 tumors of 5 other histologic types. NKX3.1 was positive in MGA (2/2, 100%), whereas all constituent cells, including mucinous cells, were negative for NKX3.1 in other histologic types (0%, 0/19). In normal lung tissue, NKX3.1 was positive for mucinous acinar cells of the bronchial glands. In conclusion, the gene expression profile, taken together with the histologic similarity between MGA and bronchial glands, and the preferred location of the tumors (proximal airways with submucosal glands) suggest that MGA is a neoplastic counterpart of mucinous bronchial glands. NKX3.1 immunohistochemistry can be a sensitive and specific ancillary marker that distinguishes MGA from other histologic mimics.
Collapse
Affiliation(s)
- Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan; Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
| | - Katsuhiro Masago
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshihito Kogure
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; Department of Medical Oncology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Shiro Fujita
- Department of Respiratory Medicine, Kobe Central Hospital, Kobe, Japan
| | - Akari Iwakoshi
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; Department of Pathology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan
| | - Koji Tsuta
- Department of Pathology, Kansai Medical University, Hirakata, Japan
| | - Hirokazu Matsushita
- Division of Translational Oncoimmunology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Evangelou Z, Froudarakis M, Ntolios P, Papoudou-Bai A, Anevlavis S, Gkrepi K, Batistatou A, Karpathiou G. Solitary glandular papilloma of the lung with molecular analysis: A case report and literature review. Pathol Res Pract 2020; 216:152905. [PMID: 32139260 DOI: 10.1016/j.prp.2020.152905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/12/2020] [Accepted: 02/27/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Solitary papillomas of the lung are rare. One of their subtypes is glandular papilloma with only a very few cases described in the literature. We describe a case of pulmonary glandular papilloma with emphasis in its differential diagnosis and its molecular analysis. CASE DESCRIPTION A 64-years old former smoker was incidentally found to have an endobronchial tumor of the right main bronchus. Microscopic and immunohistochemical findings revealed a glandular papilloma. EGFR, KRAS and BRAF V600E mutation analysis, as well as HPV detection analysis revealed no mutation or HPV infection. Detailed differential diagnosis and literature review are presented. CONCLUSION Glandular papillomas of the lung are usually central, affecting older patients than squamous or mixed squamous cell and glandular papillomas. In previously reported cases, one glandular papilloma with KRAS mutation and another one with BRAF mutation have been reported. The present case harbored no mutation or HPV infection.
Collapse
Affiliation(s)
- Zoi Evangelou
- Department of Pathology, University Hospital of Ioannina, Greece
| | - Marios Froudarakis
- Department of Pulmonary Medicine, Democritus University of Thrace, Greece
| | - Paschalis Ntolios
- Department of Pulmonary Medicine, Democritus University of Thrace, Greece
| | | | - Stavros Anevlavis
- Department of Pulmonary Medicine, Democritus University of Thrace, Greece
| | | | - Anna Batistatou
- Department of Pathology, University Hospital of Ioannina, Greece
| | - Georgia Karpathiou
- Department of Pathology, University Hospital of Ioannina, Greece; Department of Pathology, University Hospital of Saint-Etienne, France.
| |
Collapse
|
8
|
Wang Z, Yang MQ, Huang WJ, Zhang D, Xu HT. Sclerosing pneumocytoma mixed with a typical carcinoid tumor: A case report and review of literature. Medicine (Baltimore) 2019; 98:e14315. [PMID: 30702609 PMCID: PMC6380861 DOI: 10.1097/md.0000000000014315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RATIONALE Sclerosing pneumocytoma accompanied with other type of tumor in one patient is very rare. Here, we report a case of a sclerosing pneumocytoma mixed with a typical carcinoid tumor in a same neoplasm. PATIENT CONCERNS A 55-year-old woman incidentally detected a space-occupying lesion of right lung in routine health examination. The patient was asymptomatic and there were no positive findings in routine laboratory examination, physical examination, and pulmonary function test. Computed tomography revealed a solitary round mass in the middle lobe of the right lung. DIAGNOSIS The lesion was diagnosed as a sclerosing pneumocytoma accompanied with a typical carcinoid tumor of the right lung. INTERVENTION The patient underwent thoracoscopic lobectomy in our hospital. OUTCOMES The postoperative course was uneventful. LESSONS This case is rare and noteworthy for a lesion containing two different types of neoplasms, which may cause diagnostic difficulties.
Collapse
Affiliation(s)
- Zhao Wang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
- Department of Pathology, General Hospital of Heilongjiang Land Reclamation Bureau, Harbin
| | - Mai-Qing Yang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
- Department of Pathology, Changyi People's Hospital, Changyi, China
| | - Wen-Jing Huang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
| | - Di Zhang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
| | - Hong-Tao Xu
- Department of Pathology, the First Hospital and College of Basic Medical Sciences of China Medical University, Shenyang
| |
Collapse
|