SESSION TITLE: Cancer Case Report Posters I
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: We describe a rare case of a metastatic lung cancer in a 53 year-old asymptomatic man that was initially screened with surveillance computed tomography for 2 years without change, but noted change nine years later on a routine virtual colonoscopy. Biopsy of these lesions revealed a rare metastatic myoepithelioma that was found to be related to a lipoma-like lesion from the patient’s right big toe that was removed decades prior.
CASE PRESENTATION: A 53 year-old asymptomatic Caucasian man with a normal physical exam presented after having multiple well-circumscribed 1-2 cm rounded pulmonary nodules. He had previously had the similar but smaller and fewer pulmonary nodules on a chest x-ray 10 years prior that were discovered at a job retirement physical. These were monitored with CT scans without any change for two years. He denied any significant health history aside from having a marble-sized lipoma-like growth removed from his right foot when he was 17 years-old. This growth reappeared and was removed when he was 40 years old. A biopsy of a pulmonary nodule revealed a myoepithelioma and on further evaluation matched the histology of the toe biopsy.
DISCUSSION: Myoepitheliomas are rare tumors usually from salivary, mammary, or sweat glands. Pulmonary metastases is very rare. Epidemiologically, these tumors are often discovered incidentally in middle-aged patients. Myoepithelial tumors behave as low-grade malignant neoplasms with a long interval between the original diagnosis and the discovery of distant metastases. Histologically, these tumors are may be defined by positive stains for cytokeratin, S100 protein, GFAP, calponin, smooth muscle myosin, and p63. Given the slow growth of these tumors, the clinical course is ill-defined, however, extensive nodule growth can lead to complications such as lobar collapse and pneumothorax. There is limited but potential emerging treatments for metastatic myoepitheliomas. Long-term surveillance and follow up for changes or complications related to these lesions is advised.
CONCLUSIONS: Metastatic myoepithelioma to the lung is a rare cause of slow growing pulmonary nodules. A history of skin lesions may aid in the diagnosis. To our knowledge, this is the first reported case of a metastatic pulmonary myoepithelioma arising from the feet that was biopsied and removed decades earlier.
Reference #1: Pelosi, G. Mod Pathol 2001;14(5):521-526
Reference #2: Pierard S, et al. Eur Arch Otorhinolaryngol. 2006;263(12):1158-60
DISCLOSURE: The following authors have nothing to disclose: Nikunj Bhatt, Joel Nations
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