Pulmonary Adenofibroma

Pulmonary adenofibroma are rare lung lesion.

Age: Usually noted in adults.

Gross: Small and well circumscribed lesion.

Microscopic features: Complex branching glandular spaces lined by a single layer of cuboidal to columnar epithelium. The tumour is surrounded by a spindle cell fibrous stroma.

Immunohistochemistry: Epithelial lining cells show positive staining for cytokeratin and epithelial membrane antigen (EMA). The stroma is negative for S100-protein, actin, keratin, EMA, desmin and CD34.

Differential diagnosis: Their main importance lies in distinguishing them histologically from other types of pulmonary hamartomas, pulmonary blastomas , intrapulmonary solitary fibrous tumour , and metastases from soft tissue and visceral sarcomas.

Histopathological reporting of pulmonary parenchymal biopsies ; Closed pleural biopsy for neoplasm or inflammatory lesions ; Open pleural biopsy and pneumonectomy or pleural stripping ; Congenital Cystic Adenomatoid Malformation ; Chondroid Hamartoma ; Acute Respiratory Distress Syndrome ; Neonatal Respiratory Distress Syndrome ; Complications of Neonatal Respiratory Distress Syndrome ; Extrinsic Allergic Alveolitis ; Chronic Obstructive Pulmonary Disease ; Bronchial Asthma ; Bronchiectasis ; Chronic Bronchitis ; Emphysema ; Bronchiolitis; Lipid Pneumonia; Pulmonary Alveolar Proteinosis ; Pulmonary Thromboembolism ; Other forms of Pulmonary Embolism ; Pulmonary Infarction ; Pulmonary Hypertension ; Pulmonary Collapse (Atelectasis) and Pneumothorax ; Pulmonary Edema ; Pulmonary Hemorrhage (Eg. Goodpasture's Syndrome) ; Sarcoidosis ;Exfoliative Pulmonary Cytology ; Fine Needle AspirationCytology; Lymphangioleiomyomatosis ; Pulmonary Mesenchymal Tumours ; Primary Pulmonary Leiomyosarcoma ;Primary Pulmonary Rhabdomyosarcoma ; Primary Monophasic Synovial Sarcoma of the Lung ; Neurogenic Tumours of the Lung ; Pulmonary Malignant Fibrous Histiocytoma ; Bone and Cartilage- forming Sarcoma of the Lung ; Kaposi's Sarcoma and Angiosarcoma of the Lung ; Epithelioid Hemangioendothelioma of the Lung ; Localized Fibrous Tumour of the Pleura ;Pulmonary Lymphoproliferative Disease ; Lymphomatoid Granulomatosis ; Post-Transplant Lymphoproliferative Disease ; Biphasic Epithelial/Mesenchymal Lung Tumours ; Pulmonary Carcinosarcoma ; Pulmonary Blastoma ;Large Cell Neuro endocrine tumour;

Solitary fibrous pseudopapillary tumor of the lung: pulmonary fibroadenoma and adenofibroma revisited. Pathologica. 2003 Jun;95 (3):162-6.

We describe a peculiar pulmonary lesion, that we interpreted as a pseudopapillary variant of solitary fibrous tumor. The patient was a 62-year-old asymptomatic male, non smoking, presenting with a peripheral nodule, 0.8 cm across, located in the lower lobe of the right lung. The patient is alive and well 18 months after surgical excision of the nodule. Microscopically, the lesion was well-circumscribed and characterized by a diffuse pseudopapillary pattern. Pseudopapillae were large, and were covered by a rim of cubic epithelium devoid of atypia. The stromal axis was fibrous and contained scattered bland spindle cells. Immunohistochemically, the latter were strongly positive for vimentin and CD34, focally positive for BCL2 and CD99, negative for cytokeratin, EMA, TTF1, calretinin, smooth muscle actin, desmin and S100 protein; the epithelial cells were immunoreactive for cytokeratin, EMA and TTF1. We interpret this lesion as a peculiar pseudopapillary variant of solitary fibrous tumor, corresponding to what has been reported in the literature as pulmonary adenofibroma and fibroadenoma. The most important differential diagnostic considerations are briefly discussed.

Pulmonary adenofibroma: report of two cases of an unusual type of hamartomatous lesion of the lung.Histopathology. 1993 Dec;23(6):547-51

We report two cases of a primary lung tumour characterized by complex gland-like spaces lined by simple cuboidal to columnar epithelium surrounded by a hyalinized spindle-cell fibroblastic proliferation reminiscent of adenofibromas of the female genital tract. The lesions occurred in a 54-year-old woman and a 56-year-old man. The tumours presented clinically as 1-2 cm, solitary 'coin' lesions and were discovered incidentally on routine chest X-rays. Both lesions were treated by lobectomy. One patient is alive and well with no evidence of disease after 8 years; the other died of myocardial infarction 5 years following resection of his tumour without evidence of recurrence. We interpret these lesions as benign hamartomatous growths; their main importance lies in distinguishing them histologically from other types of pulmonary hamartomas, pulmonary blastomas, intrapulmonary solitary fibrous tumours, and metastases from soft tissue and visceral sarcomas.

June 2007