Lung Pathology: Chest Tumors |

Primary Pulmonary Salivary Gland-type Tumor: A Case Report FREE TO VIEW

Han Yan, MD; Cheng Gao, MD
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Peking University People's Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A340. doi:10.1016/j.chest.2016.02.354
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Primary lung tumors showing features of salivary gland-type neoplasms are extremely rare. We report a case of bronchial pleomorphic and mucous gland adenomas and study the expression of markers such as TTF-1 and high molecular weight keratins in the tumor. The pleomorphic adenoma also had a well-circumscribed parenchymal component, with a biphasic morphology composed of epithelial and myoepithelial cells in a background of myxoid and hyaline stroma. Epithelial cells showed strong and diffuse cytoplasmic staining with high molecular weight cytokeratins and lacked TTF-1 expression.

CASE PRESENTATION: A 33 year old female nonsmoker presenting cough with white sputum and fever visited us. A chest Xray revealed infiltrates on the right lower lobe and atelectasis. She was treated with levofloxacin and physical examination showed only fine crackles at the right lower lung field. Laboratory studies revealed the following: leukocyte count, 14.74×109/L, Neu% 72.2%. There was no elevation of tumor markers. A Chest CT scan showed a well defined non-calcified nodular lesion of the right lower lobe without enlargement of the hylar and mediastinal lymph nodes (Fig.1). Bronchoscopy revealed reddish smooth regular mass (Fig.2). A bronchial electrocision was performed. At histological examination the tumor was mostly organized in cords and nests, with a proliferation of cuboidal epithelial cells without nuclear atypia, forming broad papillae and ductal structures, from small to cystic. Mesenchymal-type cells varied from polygonal to fusiform, with oval and vescicular nuclei; myoepithelial cells were also observed. Immunoreactivity was positive for cytokeratin, EMA, vimentin, CK7 and negative for CEA glial fibrillary acid protein TTF, S-100 protein, CD34, desmin and chromogranin A. The final diagnosis was salivary gland-type pleomorphic adenoma. (Fig.3 and 4)

DISCUSSION: Salivary-gland type tumors of the lung usually originate from the epithelium of the submucosal bronchial gland. They, therefore, usually present as endoluminal lesions and rarely occur in peripheral or subpleural locations [1]. The presence of tumors unrelated to the bronchial structure has been explained by a possible origin from a primitive stem cell that can differentiate to a ductal structure, myoepithelium and chondroid or myxoid matrix [2,3].

CONCLUSIONS: Pleomorphic adenomas of the lung are rare tumors with a potentially malignant behavior. Long-term follow-up after treatment is mandatory due to the possibility of malignant progression.

Reference #1: Arimasa shirasaki, et al. A salivary gland-type monomorphic adenoma with trabecular proliferation in the lung. Internal medicine Vol34, No 11,1995, Nov:1086-1088.

Reference #2: Angelo Carretta, et al. Salivary gland-type mixed tumor (pleomorphic adenoma) of the lung. Interactive CardioVascular and Thoracic Surgery 3 (2004):663-665.

Reference #3: Julian R. Molina, et al. Primary Salivary Gland-type Lung Cancer. Cancer. Nov15, 2007;Vol 110;(10):2253-2259.

DISCLOSURE: The following authors have nothing to disclose: Han Yan, Cheng Gao

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