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Prognosis of mucoepidermoid carcinoma of the bronchi.Rev
Pneumol Clin. 2007 Feb;63(1):29-34.
BACKGROUND:
Mucoepidermoid cancer is exceptional in the respiratory tract,
accounting for only 0.2% of primary lung cancers. CASE REPORTS: We
report three cases of mucoepidermoid carcinoma. The inaugural signs
were hemoptysia in a 10-year-old child, recurrent lower respiratory
tract infections in a 13-year-old child, and dyspnea with chest pain
in a 32-year-old adult. Bronchial fibroscopy disclosed a proximal
endobronchial tumor in all three patients. Pathology study of the
operative specimen identified low-grade malignant mucoepidermoid
carcinoma in the two children and high-grade malignant mucoepidermoid
carcinoma in the adult. Surgical resection was performed for the
pediatric cases. Outcome was favorable with recurrence-free survival
at eight years in the first child. The surgical resection was less
radical in the second child due to locoregional extension. This child
was lost to follow-up. The clinical course was rapidly fatal in the
third patient who presented metastatic spread at diagnosis and died
one month later.DISCUSSION: The prognosis of mucoepidermoid tumors of
the bronchi is closely related to tumor grade and extension at
diagnosis. Unlike high-grade mucoepidermoid carcinoma, the progression
of low-grade tumors, which predominate in children, is generally slow,
enabling good prognosis if diagnosis is established early. Early
search for these tumors in patients presenting chronic or recurrent
respiratory manifestations would avoid late diagnosis and improve
prognosis.
Pulmonary
mucoepidermoid carcinoma with prominent tumor-associated lymphoid
proliferation.Am
J Surg Pathol. 2005 Mar;29(3):407-11.
We report 6
cases of low-grade pulmonary mucoepidermoid carcinoma displaying a
striking lymphoplasmacytic infiltrate. All six tumors had a typical
pulmonary mucoepidermoid carcinoma presentation as a polypoid
endobronchial mass involving the proximal bronchi. The patients were 3
females and 3 males with a mean age of 33 years (range, 5-61 years).
Half of the patients were asymptomatic, while half experienced mild
symptoms of pneumonia, asthma-like symptoms, or hemoptysis. No
tumor-related deaths were observed, with a mean follow-up of 51
months. The tumor size ranged from 2.1 to 3.4 cm (mean, 2.9 cm). The
tumors characteristically displayed an elaborate tubulocystic
epithelial component composed of intermediate, epidermoid, and
mucus-producing cells, and variable numbers of clear cells,
multinucleated giant cells, columnar cells, and oncocytic cells. The
tumors' lymphoplasmacytic infiltrate with occasional Russell bodies
was sufficiently intense to raise concern of a low-grade lymphoma. All
tested tumors were immunoreactive with CK7 while nonreactive with
TTF-1 and CK20. Recognition of this histologic variant is important
for a correct diagnosis of low-grade pulmonary mucoepidermoid
carcinoma. The dense lymphoplasmacytic infiltrate is similar to that
previously described in salivary glands as tumor-associated lymphoid
proliferation.
Mucoepidermal
carcinoma of the lung detected by positron emission tomography in a
5-year-old girl.J
Pediatr Surg. 2005 Apr;40(4):E1-3.
The
authors describe a rare case of mucoepidermal carcinoma of the lung
incidentally identified in preoperative assessments for inguinal
hernia repair in a 5-year-old girl. This patient was referred for
right external inguinal hernia, and a 3.0-cm round-shaped lesion was
found in the right lower lung field of a chest x-ray film. She had no
respiratory tract complaints, but her serum carcinoembryonic antigen
concentration was markedly elevated (21.2 ng/mL). Chest and abdominal
computed tomography/magnetic resonance images could not determine the
nature of the lesion, but 2-[18 F]fluoro-2-deoxy- d -glucose positron
emission tomography (FDG-PET) indicated a malignant tumor pattern. The
patient underwent a computed tomography-guided needle biopsy of the
lesion (S8), which was soon followed by a right lower pulmonary
lobectomy. Histopathology of the resected specimen showed
mucoepidermal carcinoma with no regional lymph node metastasis. In
childhood asymptomatic pulmonary lesions, it is often difficult to
rule out the possibility of malignancy. In the present case, FDG-PET
scanning appropriately indicated the therapeutic priority of pediatric
thoracic surgery.
Mucoepidermoid
carcinoma as an unusual cause for recurrent respiratory infections in
a child.
J Pediatr Hematol Oncol.
2005 Mar;27(3):162-5.
Recurrent
respiratory infections in a 9-year-old girl prompted a chest
radiograph and a CT scan, which showed a right middle lobe
consolidation. Bronchoscopy revealed a tumor that totally obstructed
the middle lobe. Open lung biopsy revealed a low-grade mucoepidermoid
carcinoma. Middle and lower right lung lobectomy was performed,
followed by an uneventful recovery. Cytogenetic investigation of tumor
cells exhibited the translocation t(11;19). This case shows that
further diagnostic modalities such as CT scanning should be performed
early in children with recurrent lower respiratory tract infections
who have suspicious radiographic findings such as persistent
atelectasis or recurrent unifocal infiltration. Bronchial
mucoepidermoid carcinoma is infrequent, and molecular investigations
might shed additional light on the prognosis.
Bronchoscopic
Nd-YAG laser surgery for tracheobronchial muco- epidermoid carcinoma--a
report of two cases. Int
J Clin Pract. 2004 Oct;58(10):979-82.
Mucoepidermoid
carcinoma (MEC) of the tracheobronchial tree represents 0.2% of all
lung tumours. It arises from the excretory ducts of the bronchial
mucosa and is classified into low- and high-grade tumours using
criteria derived from similar tumours of the major salivary glands.
Low-grade MEC behaves in a benign fashion with less parenchymal and
hilar lymph nodal invasion. The traditional method of treatment is by
thoracotomy. The bronchoscopic approach to this lesion using lasers
has rarely been reported. This article reports two cases of low-grade
tracheobronchial MEC, which were both managed through bronchoscopic
neodymium yttrium aluminium garnet (Nd-YAG) laser surgery. The
patients were free from disease, 26 and 36 months after surgery.
Bronchoscopic laser surgery promises to be an effective alternative
treatment modality for tracheobronchial MEC. It is minimally invasive,
results in less hospital stay and does not impair pulmonary functions.
Mucoepidermoid carcinoma of the lung presenting as a cavitary lesion.J
Med Assoc Thai. 2004 Aug;87(8):988-91.
The authors
describe a 62-year-old female patient who presented with a
progressively enlarging cavitary lesion in the right upper lobe of the
lung. Acid-fast bacilli were recovered from a bronchial washing fluid
and identified as Mycobacterium tuberculosis. She received
antituberculous therapy for 5 months without improvement in her
clinical symptoms and chest radiograph. A lobectomy was performed and
pathological review demonstrated a high-grade mucoepidermoid lung
carcinoma with extensive central necrosis. Staging revealed metastases
in her left adrenal gland, kidney and spine. High-grade mucoepidermoid
carcinoma of the lung may present as a cavitary lesion. The presence
of M. tuberculosis should not preclude clinicians from pursuing
adequate diagnostic procedures for a possible malignant lesion.
Mucoepidermoid
carcinoma of the bronchus presenting with a negative chest X-ray and
normal pulmonary function in two teenagers: two case reports and
review of the literature.Pediatr
Pulmonol. 2004 Jan;37(1):81-4.
Two
adolescents presented with a history of dyspnea upon exertion and
cough. In both cases, the chest X-ray and pulmonary function testing,
including flow-volume loop, were normal. A bronchial tumor was
diagnosed by CT scan, which was ordered after each patient had an
episode of hemoptysis. The sedimentation rate was the only abnormal
laboratory test in both cases. Mucoepidermoid carcinoma of the
bronchus, a rare tumor in childhood, was found at pathology in both
cases. There was no evidence of metastases to local lymph nodes or
distal sites. There were 47 previously reported cases in children.
Recurrent pneumonia and persistent cough were the most common
presenting findings. These tumors are of low-grade malignant potential
but they can become locally invasive, extending into cartilage and
surrounding soft tissue. Prognosis is good with complete resection.
Intranuclear
inclusions in fine needle aspirates of bronchial low grade
mucoepidermoid carcinoma with clear cell change: a report of two
cases.
Acta Cytol. 2002 Jan-Feb;46(1):57-60.
BACKGROUND:
Mucoepidermoid carcinoma of the bronchus is a rare neoplasm that can
be recognized on histology as well as cytology by the presence of
three characteristic cell types: mucus secreting, epidermoid and
intermediate. We encountered two cases displaying unusual cytologic
features, including clear intranuclear inclusions. CASES: Two females,
aged 33 and 39, presented with an intrabronchial tumor and pulmonary
parenchymatous mass, respectively. Fine needle aspiration of both
tumors showed similar cytologic features, with a dominant population
of cells with bland nuclei and wide cytoplasm, and frequent
intranuclear inclusions. A minor component of mucus-secreting cells
was also recognized. Histologically, both tumors corresponded to the
clear cell variant of mucoepidermoid carcinoma. CONCLUSION: The
cytologic picture in our cases has not been described previously in
fine needle aspirates of mucoepidermoid carcinoma, in neither the
bronchus nor salivary gland. The differential diagnosis of a
monotonous population of epithelial cells with intranuclear inclusions
involves bronchioloalveolar carcinoma, but the absence of the
characteristic sheet pattern, as well as the clinical and image
findings, excludes this possibility. The lack of atypia and
intrabronchial location limits the scope to carcinoid and salivary
gland-type tumors of the bronchus. Since we were aware of the
possibility of unusual cytologic presentations of mucoepidermoid
carcinomas, search for different cellular populations suggested the
precise diagnosis.
Three cases of
pulmonary mucoepidermoid carcinoma.Kyobu
Geka. 2000 Jul;53(8 Suppl):702-5.
Three cases of
pulmonary mucoepidermoid carcinoma, which were surgically treated in
our hospital, were reported. The first case was 28-year-old male, who
had hemoptysis, underwent right upper lobectomy and mediastinal lymph
node dissection on October 31, 1973. The tumor located and obstructed
the ostium of right B2. The diameter was 2.3 x 1.8 cm. The second case
was 63-year-old male, who had obstructive pneumonia, underwent left
upper lobectomy and mediastinal lymph node dissection on November 18,
1998. The tumor located and obstructed the ostium of lingular
bronchus, and the diameter was 1.8 x 1.2 cm. The third case was
25-year-old male, who had obstructive pneumonia, underwent left sleeve
lower lobectomy and mediastinal lymph node dissection on May 26, 1999.
The tumor located in ostium of left B6, and it obstructed lower
bronchus and expanded into the lung. The diameter was 4 x 2 cm. All
cases were diagnosed as low grade malignancy with no lymph node
metastasis. The first case survived without recurrence at least 5
years as far as we followed, and the others are surviving until now
without any signs of recurrence. These three cases were 0.19% of total
resected lung cancers in our hospital from 1969 to 1999.
Cytology of
primary pulmonary mucoepidermoid and adenoid cystic carcinoma. A
report of four cases.Acta
Cytol. 1999 Nov-Dec;43(6):1091-7.
BACKGROUND: Mucoepidermoid and adenoid cystic carcinomas are very rare
primary pulmonary neoplasms that can be classified under the broader
heading of salivary gland-like neoplasms (SGN). Both entities need to
be considered in the cytologic differential diagnosis of lung tumors.
We reviewed cytologic findings in primary pulmonary neoplasms
diagnosed at our institution during the time period 1981 to the
present along with outside consultation cases. CASES: Three cases of
primary mucoepidermoid carcinoma and one case of primary adenoid
cystic carcinoma of the lung were diagnosed based on cytology during
the period examined. Patient ages were 16, 25, 47 and 78 years,
respectively. The mucoepidermoid cytology specimens were composed of
three cell types, mucinous, squamous and intermediate cells, at times
associated with extracellular mucin. The adenoid cystic carcinoma
consisted of small, uniform cells with dark nuclei, scant cytoplasm
and associated, acellular balls of basement membrane material.
CONCLUSION: The differential diagnosis for primary pulmonary neoplasms
needs to include the rare SGN. Cytologic features of adenoid cystic
carcinoma are diagnostic; those of mucoepidermoid carcinoma are at
least suggestive.
Mucoepidermoid carcinoma of the
tracheobronchial tree: radiographic and CT findings in 12 patients.Radiology.
1999 Sep;212(3):643-8.
PURPOSE:
To determine the radiographic and computed tomographic (CT) findings
and clinical features of mucoepidermoid carcinoma of the
tracheobronchial tree. MATERIALS AND METHODS: Chest radiographic and
CT findings and clinical features of 12 histopathologically proved
mucoepidermoid carcinomas in 12 consecutive patients (five male, seven
female; age range, 9-72 years; mean age, 36 years) were reviewed
retrospectively. RESULTS: The tumors were located at the distal
trachea (n = 1) or at a main (n = 2), lobar (n = 1), or segmental (n =
8) bronchus. On chest radiographs, the tumors appeared as central
masses with post-obstructive pneumonia or peripheral atelectasis in
four patients and as solitary pulmonary or endotracheobronchial
nodules in eight. At CT, the tumors were all smoothly oval (n = 6) or
lobulated (n = 6) in shape (ranging 9-40 mm in diameter), adapting to
the branching features of the airways. Punctate calcification within
the tumor was seen in six patients. Neither metastasis nor recurrence
was seen after the surgical resection (follow-up of 8-103 months;
mean, 30 months). CONCLUSION: Mucoepidermoid carcinoma of the
tracheobronchial tree, usually located in a segmental bronchus,
appears at CT as a smoothly oval or lobulated airway mass. It adapts
to the branching features of the airways.
Tracheobronchial
mucoepidermoid carcinoma in childhood and adolescence: case report and
review of the literature.Int
J Pediatr Otorhinolaryngol. 1998 Oct
15;45(3):265-73.
In children
and adolescents, primary neoplasms of the tracheobronchial tree and
lungs are rare, with most tumors involving the respiratory system
being metastatic, small, blue cell tumors of childhood. Of the primary
pulmonary neoplasms, most are malignant with mucoepidermoid carcinoma
representing about 10% of these malignant tumors. We present an
8-year-old Hispanic male with hemoptysis and several episodes of
pneumonia which initially was thought to be infectious upon biopsy
during bronchoscopy, but proved to be mucoepidermoid carcinoma of the
tracheobronchial tree by microscopic examination during an open lung
biopsy. This rare tumor is more common in adults than in children, and
infrequently presents with hemoptysis. Mucoepidermoid tumors of the
tracheobronchial tree carry a more favorable prognosis in children
than adults. In the adult population, the overall mortality is
slightly less than 30%. In contrast, of the 31 reported cases of
tracheobronchial mucoepidermoid carcinoma in pediatrics, all children
are free of tumor involvement with a mean follow-up period of 5.8
years (range, 0.7-21 years). Based upon the available clinical outcome
and survival data, it would appear that tracheobronchial
mucoepidermoid carcinoma may be successfully managed by surgical
intervention alone in children and adolescents.
A child with a
t(11;19)(q14-21;p12) in a pulmonary mucoepidermoid carcinoma.Virchows
Arch. 1998 Dec;433(6):579-81.
We report on a
mucoepidermoid carcinoma (MEC) of the lung in a 6-year-old girl with a
t(11;19)(q14-21;p12) as the sole karyotypic abnormality. An apparently
identical t(11;19) has been reported previously in a MEC originating
from the major and minor salivary glands. Our findings indicate that
the t(11;19) is intimately associated with the mucoepidermoid
phenotype and may be used as a diagnostic marker for this tumour type.
An
experience with surgical treatment for mucoepidermoid carcinoma of the
lungs.Kyobu
Geka. 1993 Nov;46(12):1077-9.
Mucoepidermoid
carcinoma (MEC) of the lungs is thought to arise in the bronchial
glands. It is a tumor that rarely develops and it has a low grade of
malignancy. In this paper, we describe one case of infiltrative MEC,
which we were able to diagnose preoperatively. Surgery revealed a high
grade malignancy which is reported here with a discussion based on the
related literature. The patient was a 63-year-old male who was
referred to our hospital by another physician due to a cough and left
chest pain. A simple chest X-ray revealed a tumor shadow and a
fascicular shadow on its periphery in the upper left lobe.
Bronchoscopy disclosed complete circumferential stenosis at B1+2,3 and
reddening from this region to the main bronchus, but it was impossible
to directly confirm the tumor. Pulmonary arterography did not depict
the left upper pulmonary vein, but obstruction due to a tumor of that
vein was observed. Given the above findings, under a diagnosis of
infiltrative MEC, a left total lobectomy accompanied by a combined
left atriectomy was performed. Although most cases of MEC have a low
grade malignancy, there have been some reported cases with a very high
grade of malignancy. Therefore, evaluation of the progress of this
type of carcinoma by preoperative diagnosis as well as radical
excision appropriate to lung cancer are considered to be important.
Peripheral
low-grade mucoepidermoid carcinoma of the lung--needle aspiration
cytodiagnosis and histology.Cytopathology.
1992;3(4):259-65.
Mucoepidermoid carcinoma of the lung is a rare tumour, and is not
usually considered in the differential diagnosis of a peripheral lung
mass. The cytological and histological features of an intimate
admixture of polygonal intermediate cells, well differentiated
mucinous and squamous cells, as illustrated in this case report, serve
to differentiate a well differentiated mucoepidermoid carcinoma from
adenosquamous carcinoma, low grade adenocarcinoma, bronchioloalveolar
carcinoma, and benign reactive changes.
Childhood
tracheobronchial mucoepidermoid carcinoma: a case report and review of
the literature.J
Pediatr Surg. 1988 Apr;23(4):367-70.
Mucoepidermoid
carcinoma of the lung presenting in childhood is an uncommon neoplasm.
Symptoms of progressive bronchial obstruction proceed the recognition
of this lesion. The well-confined local growth and minimal metastatic
potential of childhood mucoepidermoid carcinoma make local resection
with maximum conservation of pulmonary parenchyma the recommended
operative treatment. Adequate surgical resection precludes the need
for further radiation therapy or chemotherapy. This report details the
presentation and treatment of a child with this rare tumor and reviews
the present literature experience with childhood mucoepidermoid
carcinoma.
Combined epidermoid
and adenocarcinoma in diffuse interstitial pulmonary fibrosis.Hum
Pathol. 1982 Jun;13(6):580-3.
This report
documents a case of combined epidermoid and adenocarcinoma with
idiopathic diffuse interstitial fibrosis developing in the lung. This
type of carcinoma with diffuse interstitial fibrosis occurs only
rarely in the lungs, in contrast to such carcinoma without fibrosis,
which occurs less rarely. A 79-year-old man died of respiratory
insufficiency three years after the was diagnosed as having diffuse
interstitial pulmonary fibrosis. Six months prior to his death. a
tumor shadow was noticed on a radiograph of his chest. Postmortem
examination revealed diffuse interstitial pulmonary fibrosis and a
primary lung tumor situated peripherally in the right lower lobe. The
histologic features of the tumor closely resembled those of
mucoepidermoid carcinoma of the major bronchi. However, the tumor had
no relation to any bronchi or bronchial glands, and it was evident
that no relation to any bronchi or bronchial glands, and it was
evident that it had originated from the surface epithelium of the
abnormally altered distal airspaces of the honeycomb lung. It is
suggested that the malignantly transformed cells originally possessed
the potential for bidirectional differentiation to epidermoid and
mucous cells.
Carcinoid and
mucoepidermoid carcinoma of bronchus in children.Ann
Otol Rhinol Laryngol. 1980 Sep-Oct;89(5
Pt 1):425-7.
Four patients
with bronchial carcinoid and two patients with mucoepidermoid
carcinoma of the bronchus are presented. Presenting symptoms of these
rare childhood tumors are chronic cough, hemoptysis, repeated bouts of
pulmonary infection, and chest pain. Bronchoscopic examination should
be considered in patients with these symptoms and is highly reliable
in diagnosing these tumors Surgical resection is the treatment of
choice. Bronchial carcinoid and mucoepidermoid carcinoma have an
excellent prognosis following conservative surgical resection.
Mucoepidermoid
carcinoma of the bronchus: an electron microscopic study of the low
grade and the high grade variants.Cancer.
1979 May;43(5):1720-33.
Two cases of
mucoepidermoid carcinoma of the bronchus--one a low grade tumor and
the other a high grade tumor--are presented with findings by light and
electron microscopy. This represents the first report of the
ultrastructure of mucoepidermoid carcinoma of the bronchus and
demonstrates the ultrastructural similarities between the low grade
exophytic tumor confined to the bronchus and the high grade
infiltrating tumor with lymph node and pulmonary metastases. The
ultrastructural features are similar to those described for
mucoepidermoid carcinoma of the salivary gland and are consistent with
the proposed origin of the tumor from the submucosal bronchial gland
duct. These two cases and a review of previously reported cases
indicate that, analogous to mucoepidermoid carcinoma of the salivary
glands, mucoepidermoid carcinoma of the bronchus may occur as either a
low grade or high grade variant which can be identified on the basis
of growth characteristics and histologic features.
Tracheobronchial mucoepidermoid carcinoma. Clinicopathological
features and results of treatment.J
Thorac Cardiovasc Surg. 1978
Oct;76(4):431-8.
Mucoepidermoid
carcinomas of the tracheobronchial tree are extremely uncommon and, as
a result, opinions regarding their natural history are conflicting. In
an effort to determine whether the tumors are aggressive or relatively
benign, we have collected seven well-documented, previously unreported
cases from among 4,250 primary pulmonary carcinomas and 116 bronchial
adenomas. The two tracheal and five endobronchial lesions presented
here include one high-grade and six low-grade tumors. Curative
resections were performed, including segmental tracheal resections in
two patients, lobectomy in three patients, and pneumonectomy in two
patients, and the follow-up is complete to the time of this report.
Long-term survivals ranging from 5 to 23 years, averaging 12.8 years,
have been achieved in the six patients with a low-grade carcinoma. The
one high-grade variant proved fatal within 28 months of diagnosis
despite two surgical attempts at control and radiotherapy. It is
concluded that these tumors exhibit a spectrum of virulence with
low-grade lesions amenable to long-term surgical cure. The optimum
treatment of high-grade lesions remains problematical. |
