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Lung Cancer |

Primary Salivary Gland Type Neoplasm in the Lung: A Rare Finding

Sandhya Sharma, MD; Abhash Joshi, MD; Amir Bista, MD; Kevin Charles, MD; Bradley Lash, MD
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Robert Packer Hospital, Sayre, PA


Chest. 2015;148(4_MeetingAbstracts):580A. doi:10.1378/chest.2256994
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Abstract

SESSION TITLE: Lung Cancer Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: It is quite unusual to find primary salivary gland type tumor in the lung. Mucoepidermoid Carcinoma (MEC) most often arises from parotid or submandibular salivary glands. MEC of the lung has an incidence of 0.1 to 0.2% of all lung neoplasms 1. We report a case of MEC of the lung.

CASE PRESENTATION: 50 y/o healthy male, ex-smoker, presented with complaints of right sided back and chest pain for 1 week. Pain was pleuritic, with dry cough but no fever, hemoptysis or shortness of breath. He had an unintentional weight loss of 10 lbs in 2 months. Chest X-ray was done which showed right lower lobe consolidation for which he was treated with Augmentin,but his symptoms did not resolve. Hence, CT Chest was done which showed 2.4 cm right lower lobe mass occluding the bronchus and lower lobe collapse. Bronchoscopy and biopsy was done which showed endobronchial mass in the right lower lobe bronchus near occluding the anterior basilar segment. Histopathology of the lesion showed uniform gland-like spaces containing mucin, with scattered goblet like cells and squamoid cells, favoring mucoepidermoid carcinoma. He had no evidence of metastatic disease in PET scan and staging CT scan, with normal head and neck area. Patient underwent right lower lobe thoracotomy with lymph node dissection. He was found to have negative margins with no nodal disease. He did not receive adjuvant chemotherapy. Patient is being followed up yearly with imaging study showing no evidence of disease so far.

DISCUSSION: MEC of lung was first described by Smetana in 1952. It can occur in almost all age group, including children.They usually present with non specific symptoms like cough, hemoptysis or post obstructive pneumonia. Histologically, these tumors are classified into low grade and high grade based on mitotic activity, presence of necrosis, and nuclear pleomorphism. Low grade tumors have an excellent prognosis after surgical resection, however high grade tumors have risk of recurrence, metastasis and death2. Surgical resection is the main treatment. There is no role of adjuvant or targeted chemotherapy, or radiation therapy in low grade tumor. Effective treatment for high grade has not been established due to its low incidence. Some studies have reported the use of Tyrosine kinase inhibitors; however, its role is yet to be determined2.

CONCLUSIONS: MEC is a rare form of lung cancer which is classified into low grade and high grade based on histological characteristics. Low grade MEC has excellent prognosis after surgical resection, while high-grade MEC has poor prognosis with estimated 5 year survival of 35%2.

Reference #1: H. K. Leonardi, Y. Jung-Legg, M. A. Legg, and W. B. Neptune, “Tracheobronchial mucoepidermoid carcinoma. Clinicopathological features and results of treatment,” Journal of Thoracic and Cardiovascular Surgery, vol. 76, no. 4, pp. 431-438, 1978

Reference #2: Vadasz P, Egervary M. Mucoepidermoid bronchial tumors: a review of 34 operated cases. Eur J Cardiothorac Surg. 2000;17:566-569

DISCLOSURE: The following authors have nothing to disclose: Sandhya Sharma, Abhash Joshi, Amir Bista, Kevin Charles, Bradley Lash

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