SESSION TITLE: Cancer Case Report Posters I
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Epithelial-myoepithelial carcinoma (EMC) of the lung is a very rare neoplasm  with only around 25 cases reported.
CASE PRESENTATION: A 44-year-old non-smoking african-american female presented to the emergency department after she had expectorated `a half-cup of fresh blood’. She denied dyspnea or chest pain. Physical examination and laboratory values were unremarkable. Chest roentgenogram showed a 2.8cm smooth right middle lobe (RML) nodule. Chest CT revealed a 2.8cmX2.1cm circular, smooth, soft tissue density in the RML without any lymphadenopathy. Spirometry showed FEV1 of 74% and FVC of 79% predicted. On fiberoptic bronchoscopy, blood clots were noted in the RML. Pathology of the bronchoalveolar lavage showed reactive bronchial cells and macrophages. Because suspicion of neoplasm remained high, right middle lobectomy was performed. The patient recovered well and is symptom free at six months. Pathology: Grossly, the tumor was solitary, 3.5X2.8X2.6cm in size and confined to the lung. The resection margin, visceral pleura and peribronchial lymph nodes were free of tumor. Histologically, the tumor was well-circumscribed, low-grade without lymphovascular or perineural invasion. It was composed of small-medium sized cells with a moderate amount of pale eosinophilic to clear cytoplasm. The cells had somewhat irregular, ovoid, vesicular nuclei and were arranged in clusters, nests and cords with focal ductular formation. Immunohistochemistry: The cells expressed EMA, cytokeratin5/6, BerEP4, vimentin, D2-40, and CD99. Calponin was strongly positive. WT-1, calretinin, CD31, CD34, SMA, Factor 8, pankeratin, P63, desmin, CD21, CD35, chromogranin, synaptophysin, Napsin and TTF-1 were all negative. CAM5.2 and S100 were partially positive. The consensus diagnosis was EMC of the lung.
DISCUSSION: WHO defines EMC as tumors consisting of myoepithelial cells with spindle cell, clear cell or plasmacytoid morphology and varying amounts of duct-forming epithelium . EMC of the lung is considered to be very rare, low grade malignant neoplasm with histological features similar to EMC of the salivary glands .
CONCLUSIONS: The histological pattern of EMC vary considerably creating a diagnostic challenge. Given the rarity of tumor recurrence, surgical resection without adjuvant chemotherapy or radiation seems to be the treatment of choice .
Reference #1: Nguyen CV, Suster S, Moran, CA. Pulmonary epithelial-myoepithelial carcinoma: a clinicopathologic and immunohistochemical study of 5 cases. Human Pathology 2009; 40:366-373
Reference #2: Fonseca I, Soares J. Epithelial-myoepithelial carcinoma. In: Barnes L, et al. editors, World Health Organization classification of tumours, pathology and genetics of head and neck tumours, Lyon, France: IARC Press; 2005:225-6
DISCLOSURE: The following authors have nothing to disclose: Pranabh Shrestha, Enis Alberaqdar, Nalini Parikh, Javier Dieguez, Sami Abdul Jawad, Srijana Rai, Richard Miller
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