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Horio Y, Kuroda H, Masago K, Matsushita H, Sasaki E, Fujiwara Y. Current diagnosis and treatment of salivary gland-type tumors of the lung. Jpn J Clin Oncol 2024; 54:229-247. [PMID: 38018262 DOI: 10.1093/jjco/hyad160] [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: 09/13/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
Salivary gland-type tumors of the lung are thought to originate from the submucosal exocrine glands of the large airways. Due to their rare occurrence, reports of their study are limited to small-scale or case reports. Therefore, daily clinical practices often require a search for previous reports. In the last 20 years, several genetic rearrangements have been identified, such as MYB::NF1B rearrangements in adenoid cystic carcinoma, CRTC1::MAML2 rearrangements in mucoepidermoid carcinoma, EWSR1::ATF1 rearrangements in hyalinizing clear cell carcinoma and rearrangements of the EWSR1 locus or FUS (TLS) locus in myoepithelioma and myoepithelial carcinoma. These molecular alterations have been useful in diagnosing these tumors, although they have not yet been linked to molecularly targeted therapies. The morphologic, immunophenotypic, and molecular characteristics of these tumors are similar to those of their counterparts of extrapulmonary origin, so clinical and radiologic differential diagnosis is required to distinguish between primary and metastatic disease of other primary sites. However, these molecular alterations can be useful in differentiating them from other primary lung cancer histologic types. The management of these tumors requires broad knowledge of the latest diagnostics, surgery, radiotherapy, bronchoscopic interventions, chemotherapy, immunotherapy as well as therapeutic agents in development, including molecularly targeted agents. This review provides a comprehensive overview of the current diagnosis and treatment of pulmonary salivary gland tumors, with a focus on adenoid cystic carcinoma and mucoepidermoid carcinoma, which are the two most common subtypes.
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Affiliation(s)
- Yoshitsugu Horio
- Department of Outpatient Services, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Thoracic Surgery, Teikyo University Hospital, Mizonokuchi, Kanagawa-prefecture, Japan
| | - Katsuhiro Masago
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hirokazu Matsushita
- Division of Translational Oncoimmunology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Liao QN, Fang ZK, Chen SB, Fan HZ, Chen LC, Wu XP, He X, Yu HP. Pleomorphic adenoma of the trachea: A case report and review of the literature. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Liao QN, Fang ZK, Chen SB, Fan HZ, Chen LC, Wu XP, He X, Yu HP. Pleomorphic adenoma of the trachea: A case report and review of the literature. World J Clin Cases 2020; 8:6026-6035. [PMID: 33344601 PMCID: PMC7723722 DOI: 10.12998/wjcc.v8.i23.6026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pleomorphic adenoma (PA) is the most common benign tumor that occurs in the salivary glands; however, tracheobronchial PA is rarely observed. To the best of our knowledge, fewer than 50 cases have been reported in the literature. We report a 49-year-old woman who had been treated for asthma for 2 years before being diagnosed with PA of the trachea.
CASE SUMMARY A 49-year-old woman was referred to our hospital due to dyspnea upon exertion and chronic cough with wheezing for 2 years. Laboratory tests showed an elevated white blood cell count, absolute neutrophil count, and percentage of neutrophils. A chest computerized tomography scan showed a well-defined, soft-tissue density lesion measuring 2.4 cm × 2.1 cm in the lower trachea. Flexible bronchoscopy revealed that nearly 90% of the tracheal lumen was obstructed. The histopathological and immunohistochemistry features suggested PA of the trachea. Furthermore, we review the characteristics of 29 patients with tracheobronchial PA over the last 30 years.
CONCLUSION Tracheobronchial PA occurs without gender predominance, mostly in the lower or upper trachea, and has a low recurrence rate. The median age at diagnosis is 48 years. The most common symptoms are cough, stridor, dyspnea, and wheezing.
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Affiliation(s)
- Qian-Nuan Liao
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Ze-Kui Fang
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Shu-Bing Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Hui-Zhen Fan
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Li-Chang Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Xi-Ping Wu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Xi He
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Hua-Peng Yu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
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Goto T, Maeshima A, Akanabe K, Hamaguchi R, Wakaki M, Oyamada Y, Kato R. Bronchial pleomorphic adenoma coexisting with lung cancer. Ann Thorac Cardiovasc Surg 2011; 17:174-7. [PMID: 21597416 DOI: 10.5761/atcs.cr.09.01516] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 02/12/2010] [Indexed: 12/17/2022] Open
Abstract
Pleomorphic adenoma usually occurs in the salivary glands but rarely in the trachea or bronchi. A 71-year-old man had abnormal shadows on a chest X-ray. Chest CT revealed one tumor in the right basal segment of the lung and another, in the left main bronchus. Bronchoscopic biopsy of the right tumor revealed well-differentiated squamous cell carcinoma. Right lower lobectomy and lymph node dissection were performed (pT2N0M0, stage IB). At the orifice of the left main bronchus, bronchoscopy identified a polypoid lesion nearly obstructing the airway. The lesion was resected with hot snare ablation. The histological examination revealed a mixture of epithelial and myxoid mesenchymal elements, characterized by ductal structures, squamous metaplasia, and cartilage tissue. The diagnosis was bronchial pleomorphic adenoma coexisting with squamous cell carcinoma of the lung.
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Affiliation(s)
- Taichiro Goto
- Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Japan.
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Abstract
Primary pleomorphic adenoma of the trachea is rare, as only 33 cases have been previously reported worldwide since 1922. We describe a new case of primary tracheal pleomorphic adenoma that was discovered incidentally in a 78-year-old man. The tumor was excised, and the patient recovered without complication. Salivary gland tumors of the trachea should be considered in the differential diagnosis of tracheal lesions; the diagnosis is confirmed by pathologic evaluation. Patients are adequately treated with sleeve resection and primary anastomosis whenever possible.
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Affiliation(s)
- Michael J. Rodriguez
- From the Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine
| | - Giovana R. Thomas
- From the Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine
| | - Uzma Farooq
- Department of Pathology, University of Miami Miller School of Medicine
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Matsubara M, Yasuo M, Tanabe T, Tsushima K, Urushihata K, Yamamoto H, Hanaoka M, Koizumi T, Fujimoto K, Kubo K, Yamazaki Y, Uehara T. Pleomorphic adenoma with an endobronchial resection. Intern Med 2008; 47:1117-20. [PMID: 18552469 DOI: 10.2169/internalmedicine.47.0853] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A case of bronchial pleomorphic adenoma is herein presented. The patient came to the hospital for a detailed examination of a bronchial polyp that was detected by computed tomography. Chest computed tomography revealed a bronchial tumor which was located at the distal end of the left main bronchus. The patient refused surgical resection. An electrosurgical snare was performed two times and the patient received several rounds of argon plasma coagulation with a flexible bronchoscope. The diagnosis of a pleomorphic adenoma was made following examination of the resected specimens. No recurrence has been observed by biopsy at the resected site.
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Affiliation(s)
- Mikako Matsubara
- The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto
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Abstract
BACKGROUND Tracheal tumors are uncommon, making up only 0.2% of all respiratory malignancies in the United States. One consequence of this low incidence is that few centers accumulate meaningful experience. Another is the lack of awareness of effective therapy. Bronchial gland tumors demonstrate oncologic diversity and include benign, low-grade, and high-grade malignant tumors. METHODS We reviewed the present knowledge of bronchial gland tumors of the trachea, carina, and bronchi, including the epidemiology, presentation, evaluation, tumor types, and treatment options. RESULTS The malignant bronchial gland tumors, adenoid cystic carcinoma and mucoepidermoid carcinoma, are far more common than benign mucinous cystadenoma or pleomorphic adenoma. Complete resection of localized tumors has excellent long-term results in symptomatic benign tumors. The disease-free survival after resection of malignant tumors is limited by distant metastasis and regional disease, while local recurrence is uncommon. Postoperative mediastinal radiation is now accepted adjuvant therapy. Experience at our institute demonstrates a significant survival advantage for patients with complete resection compared to unresectable patients. CONCLUSIONS Expanding knowledge of diagnostic evaluation and surgical therapy can improve the long-term survival of patients with tracheobronchial gland tumors.
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Baghai-Wadji M, Sianati M, Nikpour H, Koochekpour S. Pleomorphic adenoma of the trachea in an 8-year-old boy: a case report. J Pediatr Surg 2006; 41:e23-6. [PMID: 16863832 DOI: 10.1016/j.jpedsurg.2006.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We report a case of pleomorphic adenoma of the trachea in an 8-year-old boy who required emergency surgery for severe respiratory distress. Chest computed tomographic scan and bronchoscopy showed a relatively large mass in distal trachea and right main bronchus and destruction of the lung parenchyma. The patient was subjected to right carinal resection, pneumonectomy, and pericardial patch tracheoplasty for reconstruction of the trachea. Histopathological examination and immunohistochemical staining of tumor specimens were compatible with pleomorphic adenoma. Postoperative follow-up of this patient for a period of 6 months showed satisfactory results with no complications or tumor recurrence. We present not only a very rare benign tracheal tumor in children but also demonstrate successful usage of a free pericardial patch for tracheal reconstruction, although direct anastomosis failed to provide an adequate anastomotic lumen.
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Affiliation(s)
- Massoud Baghai-Wadji
- Department of Thoracic Surgery, Afzalipour Medical Education Centre, P.O. Box 76135-1713, 49850 Kerman, Iran.
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Oliva E, Gonzalez L, Dionigi A, Young RH. Mixed tumors of the vagina: an immunohistochemical study of 13 cases with emphasis on the cell of origin and potential aid in differential diagnosis. Mod Pathol 2004; 17:1243-50. [PMID: 15154010 DOI: 10.1038/modpathol.3800173] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mixed tumors of the vagina (MTsV) are rare benign neoplasms characterized by an admixture of well-differentiated epithelial cells and stromal-type cells in various proportions. In contrast to mixed tumors in other anatomic sites, the histogenesis of the vaginal tumors is unclear. We studied the immunohistochemical profile of 13 examples to explore their histogenesis and determine whether their immunohistochemical profile might be useful in the differential diagnosis. The panel of antibodies used and the number of cases studied were: AE1/3 (12), cytokeratin 7 (CK7) (13), cytokeratin 20 (CK20) (13), epithelial membrane antigen (EMA) (13), muscle actin (MA) (12), desmin (11), h-Caldesmon (13), CD10 (13), CD34 (11), CD99 (8), and S-100 (7). Eight out of 12 tumors were positive for AE1/3, 7/13 for CK7, 2/13 for CK20, and 6/13 for EMA. MA was positive in 11/12 mixed tumors, desmin in 10/11 tumors and h-Caldesmon in 5/13. All tumors were extensively positive for CD10; CD34 was positive in 7/11; and none out of eight tumors showed membranous CD99 staining. Focal S-100 immunoreactivity was seen in 1/7 tumors. These results show that MTsV coexpress epithelial and mesenchymal markers. The expression of muscle actin (usually extensive), and focal desmin and h-Caldesmon positivity suggests the presence of a smooth muscle or myoepithelial component; however, the S-100 negativity and diffuse CD10 expression argue against it. Positivity for muscle markers does not help distinguish MTsV from smooth muscle or skeletal muscle tumors. The frequent expression of CD10 negates its use in the differential diagnosis with endometrial stromal tumors, and the CD10 and CD34 expression suggests that mixed tumors may arise from a primitive pluripotential cell. MTsV are positive for h-Caldesmon and CD10, two markers that have been used in gynecologic pathology primarily to aid in establishing the smooth muscle or endometrial stromal phenotype of a neoplasm.
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Affiliation(s)
- Esther Oliva
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Litzky L. Epithelial and soft tissue tumors of the tracheobronchial tree. CHEST SURGERY CLINICS OF NORTH AMERICA 2003; 13:1-40. [PMID: 12698636 DOI: 10.1016/s1052-3359(02)00045-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article provides a broad overview of tumors that can involve the tracheobronchial tree. For the most part, the clinical, radiographic, and endoscopic presentation of these rare tumors does not differ significantly from the more common tumors of the lung. Appropriate classification of many tracheobronchial tumors ultimately requires complete sampling and a thorough microscopic evaluation. The introduction of ancillary diagnostic techniques such as immunohistochemistry and molecular analysis will continue to refine tumor classification.
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Affiliation(s)
- Leslie Litzky
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, 6 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA.
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11
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Shaaban H, Bruce J, Davenport PJ. Recurrent pleomorphic adenoma of the palate in a child. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:245-7. [PMID: 11254420 DOI: 10.1054/bjps.2000.3536] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A rare case of recurrent pleomorphic adenoma of the palate in a 9-year-old boy is presented. Pleomorphic adenoma is relatively rare in children compared with its incidence in adults. However, it is the most common benign epithelial tumour of the salivary glands. The majority of pleomorphic adenomata in children occur in the major salivary glands, mainly the parotid gland. Pleomorphic adenomata of the minor salivary glands are rare in children and mainly occur in the palatal glands. Of the few cases of pleomorphic adenoma of the palate reported in children, only one case showed recurrence of the tumour after primary excision. We present the second case of recurrent pleomorphic adenoma of the palate in a child.
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Affiliation(s)
- H Shaaban
- Department of Plastic Surgery, Booth Hall Children's Hospital, Manchester M9 7AA, UK
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12
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Affiliation(s)
- K H Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, South Korea
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Abstract
Primary tracheal neoplasms are extremely rare lesions in the pediatric age group. This study reviews the English-language literature to better characterize these lesions in children and reports 2 additional patients. Reports of only 36 infants and children through adolescence with primary tracheal neoplasms were discovered after an exhaustive literature review of the last 30 years. The data are analyzed with regard to pathology, demographics, symptomatology, site, and percent luminal obstruction. We report 2 additional patients with photographic documentation, imaging studies, and histopathology. Of the 36 previously reported lesions, 64% were characterized as benign and 36% as malignant. Fifty-six percent of all lesions were initially misdiagnosed as asthma. The most common site was the posterior membranous wall of the cervical trachea. In 14 (39%) of the 36 patients, the lesions obstructed more than 50% of the lumen at the time of diagnosis. The timely diagnosis of tracheal masses depends upon maintaining a high index of suspicion and conducting an efficient workup, including definitive evaluation by bronchoscopy. The evaluation and the differential diagnosis of tracheal neoplasms in the pediatric population is discussed.
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Affiliation(s)
- D P Desai
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago College of Medicine, USA
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Affiliation(s)
- J Pomp
- Department of Radiotherapy, Reinier de Graaf Hospital, Delft, The Netherlands
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Bizal JC, Righi PD, Kesler KA. Pleomorphic Adenoma of the Trachea. Otolaryngol Head Neck Surg 1997; 116:139-40. [PMID: 9018277 DOI: 10.1016/s0194-59989770369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- J C Bizal
- Departments of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, USA
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