Lung Cancer: Fellow Case Report Slide: Lung Cancer |

Hemoptysis Leading to Rare Tumor Diagnosis FREE TO VIEW

Shahryar Ahmad, MD; Greg Mayhall, MD; David Johnstone, MD; Rose Franco, MD
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Medical College of Wisconsin, Milwaukee, WI

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

Chest. 2016;150(4_S):683A. doi:10.1016/j.chest.2016.08.778
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SESSION TITLE: Fellow Case Report Slide: Lung Cancer

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 23, 2016 at 03:15 PM - 04:15 PM

INTRODUCTION: Salivary gland type tumors (SGTT) of the lungs are rare but well documented in literature accounting for 0.1-0.2% of all lung tumors1. Primary epithelial-myoepithelial carcinoma (EMC) of the lung is exceedingly rare with first case described by Higashiyama et al. in 19982.

CASE PRESENTATION: A 39 year old male without any past medical history presented to our emergency department after a single episode of self limited hemoptysis triggered by vigorous coughing.Chest X-ray revealed an ovoid left lung mass with CT confirming a rounded mass like lesion with smooth borders and a surrounding ground glass infiltrate located in the anterior segment of the left upper lobe. VATS with left thoracic upper lobectomy along with lymphadenectomy was completed. The tumor was composed of sheets and islands of oval to spindle tumor cells.Immunohistochemical stains were strongly positive for cytokeratin AE1/AE3 (suspicious of salivary gland type tumor), CK18 and focally for CK5/6. The tumor also showed strong positivity for vimentin and calponin. Stain for SMA, S-100, TTF1, calretinin, PAX8, p40, p16, CK7 and CD117 were negative. This was consistent with the epithelial-myoepithelial subtype.

DISCUSSION: Primary salivary gland type tumors of lungs are exceedingly rare. They are believed to arise from submucosal glands of central airways and often present as obstructing endobronchial tumor masses. The peak incidence is in the 5th-6th decade of life without clear gender predilection. Imaging may demonstrate a well-defined mass or nodule in an endobronchial location with features of post obstructive pneumonia or atelectasis. Mucoepidermoid carcinoma (MEC) is the most common form in SGT of lung followed by adenoid cystic carcinoma (ACC). All other pulmonary SGTs including the type our patient had, epithelial-myoepithelial carcinoma, are exceedingly rare

CONCLUSIONS: Because of significant overlap in morphologic and immunohistochemical phenotype among various types of pulmonary SGT subtyping from needle biopsy material is not practical. Surgical resection is best for definitive diagnosis as well as providing more tangible prognostic information

Reference #1: Colby TV, Koss MN, Travis WD, editors. Tumors of the Lower Respiratory Tract. Atlas of Tumor Pathology. 3rd series, Fascicle13. Washington, DC: American Registry of Pathology, 1995; 65-89

Reference #2: Higashiyama M, Kodama K, Yokouchi H, Takami K, Kabuto T, Tsuji N, et al. Myoepithelioma of the lung: Report of two cases and review of the literature. Lung Cancer. 1998;20:47-56

DISCLOSURE: The following authors have nothing to disclose: Shahryar Ahmad, Greg Mayhall, David Johnstone, Rose Franco

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