|
Bronchial epithelial-myoepithelial carcinoma.Ann
Thorac Surg. 2007 Feb; 83(2):689-91.
An epithelial-myoepithelial
tumor is an extremely rare pulmonary neoplasm. Only 21 cases have been
reported to date. This report presents a case of left main bronchial
epithelial-myoepithelial carcinoma in a 43-year-old woman. No
mediastinal lymph nodes were enlarged in computed tomographic scan,
and no tumor growth was noted beyond the bronchial cartilage layer by
endobronchial ultrasound imaging. This report highlights the
usefulness of endobronchial ultrasound imaging for determining the
depth of tumor invasion and choosing an alternative approach to
surgical resection.
Bronchial
epithelial-myoepithelial carcinoma. Arch
Pathol Lab Med. 2004 Jan;128(1):92-4.
Epithelial-myoepithelial
tumor is extremely rare as a pulmonary neoplasm. Only 20 cases have
been reported to date, of which 14 were malignant. We report a case of
intrabronchial epithelial-myoepithelial carcinoma in a 73-year-old man
with a history of heavy smoking. The tumor was well-circumscribed and
caused distal airway obstruction. Histologically, the tumor showed
glandular and solid architecture. The glands were composed of an inner
layer of epithelial cells and an outer layer of myoepithelial cells.
The solid areas consisted of spindle-shaped myoepithelial cells.
Immunohistochemical staining was positive for p53 and c-Kit (CD117).
Focal atypia and increased mitotic activity were present, but no
vascular invasion or nodal metastasis was identified.
Epithelial-myoepithelial
carcinoma of the lung. A case report and review of the literature. Arch
Pathol Lab Med. 2003 Apr;127(4):e177-80.
Primary lung
tumors mimicking the salivary gland-type neoplasms are extremely rare.
These types of tumors originate from submucosal bronchial glands.
Epithelial-myoepithelial carcinoma is an uncommon tumor in this group,
and only 7 cases have been reported. It is considered to be a
low-grade malignant neoplasm. We report a case of epithelial-myoepithelial
carcinoma of bronchial gland origin in a 73-year-old man who presented
with coughing and dyspnea. The bronchus of the left lower lobe
contained a tumor mass that had a polypoid growth pattern. The tumor
also extended into the pulmonary parenchyma, forming a
well-circumscribed mass with a pushing margin. The tumor consisted of
epithelial and myoepithelial cells. The epithelial cells were positive
for cytokeratins and epithelial membrane antigen, while the
myoepithelial cells were positive for S100 protein and muscle-specific
actin. According to these findings, we diagnosed epithelial-myoepithelial
carcinoma. After undergoing pneumonectomy, the patient has been
disease free for 34 months.
Primary
salivary clear cell tumors--a diagnostic approach: a clinicopathologic
and immunohistochemical study of 20 patients with clear cell
carcinoma, clear cell myoepithelial carcinoma, and epithelial-myoepithelial
carcinoma.Arch
Pathol Lab Med. 2002 Jun;126(6):676-85.
CONTEXT:
Primary salivary clear cell tumors comprise an uncommonly encountered
subgroup of salivary neoplasia. We hypothesize that clear cell
carcinoma does not represent a "monomorphic" variant of epithelial-myoepithelial
carcinoma, but is distinct in terms of histogenesis and tumor biology.
OBJECTIVES: To compare the clinicopathologic features of 20 cases of
salivary primary clear cell tumors, including 12 clear cell carcinomas
(CCCs), 7 epithelial-myoepithelial carcinomas (EMECs), and 1 clear
cell myoepithelial carcinoma (CCMEC); to investigate their
interrelationship with regard to myoepithelial differentiation; and to
offer a diagnostic approach for distinguishing between these entities.
DESIGN: Retrospective and prospective identification and review of
patients diagnosed with primary salivary clear cell neoplasia and
review of the English language literature. SETTING: Three academic
tertiary-care hospitals. PATIENTS: We identified 12 patients with CCC,
7 with EMEC, and 1 with CCMEC. Patients included 11 men and 9 women,
aged 30 to 88 years (median 72.5 years). MAIN OUTCOME MEASURES:
Immunohistochemical reactivity for S100, muscle-specific actin, and
calponin; ultrastructural examination when feasible; review of patient
charts; and telephone interviews to establish clinical outcome.
RESULTS: Clear cell carcinoma has a predilection for intraoral sites,
whereas EMEC has a predilection for the parotid. All 3 of the tumor
types studied have a propensity for locoregional recurrence, which can
manifest decades after initial surgery. There were no mortalities
among patients with CCC, even after pulmonary metastasis in 2
patients, confirming the indolent nature of this group of clear cell
tumors. A meta-analysis of reported cases of CCC, EMEC, and CCMEC
confirmed that EMEC and CCMEC have a much greater propensity for
locoregional recurrence than CCC, despite the predilection of both for
a more surgically accessible site (parotid). We found no definitive
evidence of myoepithelial differentiation in CCC, indicating that it
is probably morphogenetically distinct from EMEC and CCMEC, both
tumors with diagnostically requisite myoepithelial differentiation.
CONCLUSIONS: The initial treatment of choice for CCC, CCMEC, and EMEC
is surgical resection with negative margins. Locoregional recurrence
should be treated aggressively, as it is still consistent with long
disease-free intervals. The lack of myoepithelial differentiation in
CCC is consistent with the concept that this tumor is
histomorphogenically distinct from EMEC and that it is not merely a
monomorphic variant.
Epithelial-myoepithelial
carcinomas of the bronchus.
Am J Surg Pathol. 2001
Dec;25(12):1508-14.
Epithelial-myoepithelial
carcinomas are very rare in the lung, and little is known about the
relationship of their histologic features to prognosis. We describe
five primary pulmonary epithelial-myoepithelial carcinomas with
details on clinical presentation, histology, and immunohistochemical
profiles. We also reviewed the literature to detail further their
prognosis. The patients' ages ranged from 33 to 57 years (average 51
years). The tumors were all endobronchial and the patients presented
with symptoms or imaging features of airway obstruction. The tumors
were completely resected; none showed nodal involvement. All five
patients are alive and free of disease 4 months to 8 years (average
4.2 years) after surgery. Four tumors showed a mixed pattern of glands
lined by a dual layer of cells and solid sheets of either spindle
cells or clear cells, the glandular and solid components being present
in variable proportions. The fifth tumor comprised purely spindle
cells. The mitotic rate was <1/20 high power fields in both the
glandular and spindle/clear cell components. In one case there was
focal nuclear pleomorphism. The inner layer of the glands stained for
cytokeratins and epithelial membrane antigen, and the outer layer for
S-100 and smooth muscle actin. In one case the spindle cells stained
for CD34. A review of published cases shows the majority of tumors
behave in an indolent fashion, the rare aggressive tumors being
predominantly myoepitheliomatous. Nevertheless, the term epithelial-myoepithelial
carcinoma is preferred because of their malignant potential. A high
mitotic rate, tumoral necrosis, and nuclear pleomorphism appear to be
adverse prognostic factors.
Pulmonary
epithelial-myoepithelial tumor of unproven malignant potential: report
of a case and review of the literature. Mod Pathol 2001; 14:521–526.
Epithelial-myoepithelial
tumors of the lung are rare neoplasms whose biological behavior and
clinical course still remain to be defined. A case of epithelial-myoepithelial
tumor of the lung arising from bronchial mucosa-submucosa and
occurring as a polypoid lesion of the upper left bronchus in a
47-year-old man is reported. The tumor did not infiltrate the
cartilaginous wall of the bronchus and showed a biphasic histological
appearance with a double layering of epithelial and myoepithelial
cells. Myoepithelial spindle cells with eosinophilic cytoplasm were
also observed. Mitotic figures were very rare and necrosis absent.
Immunohistochemical study for epithelial and muscular markers
confirmed the presence of a double-cell component in the tumor, namely
epithelial and myoepithelial. The patient is alive and well, with no
evidence of recurrent or metastatic disease 6 months after surgery. On
the basis of the present case and the six previously reported cases,
we suggest using the noncommittal term pulmonary epithelial-myoepithelial
tumor of unproven malignant potential (PEMTUMP) for this type of
neoplasm. In addition, we first introduce p63 as a novel marker for
highlighting the myoepithelial cells of the respiratory tract and
speculate on the role of these cells in the development of this
unusual tumor.
Myoepithelial carcinoma of the lung arising from bronchial submucosa.
Am J Surg Pathol. 2000
Sep;24(9):1300-4.
Myoepithelial neoplasm mainly occurs in the salivary glands and
breasts and is extremely rare in the lung. To our knowledge, this
report describes the first documented case of a myoepithelial
carcinoma present in the lung. The tumor derived from the right main
bronchial submucosa and exhibited a dual epithelial and smooth
muscular phenotype by immunohistochemical and ultrastructural studies.
It invaded the neighboring pulmonary tissue and the hilar lymph nodes.
Despite a right pneumonectomy and chemotherapy, metastasis was found
in the left lung 7 months later.
Myoepithelial
carcinoma of the lung arising from bronchial submucosa.
Am J Surg Pathol. 2000
Sep;24(9):1300-4.
Myoepithelial
neoplasm mainly occurs in the salivary glands and breasts and is
extremely rare in the lung. To our knowledge, this report describes
the first documented case of a myoepithelial carcinoma present in the
lung. The tumor derived from the right main bronchial submucosa and
exhibited a dual epithelial and smooth muscular phenotype by
immunohistochemical and ultrastructural studies. It invaded the
neighboring pulmonary tissue and the hilar lymph nodes. Despite a
right pneumonectomy and chemotherapy, metastasis was found in the left
lung 7 months later.
Epithelial-myoepithelial
carcinoma of the bronchus. Pathol Res Pract 1998;194:431–435.
An extremely
rare case of epithelial-myoepithelial carcinoma (EMC) of a lobar
bronchus in a 47-year-old female is reported. Grossly, the tumor
formed a polypoid mass obstructing the bronchial lumen.
Microscopically, it was composed of two cellular types--epithelial
cells with eosinophilic cytoplasm and clear myoepithelial cells.
Numerous tubules formed by an inner epithelial and outer myoepithelial
layer were found. Focally, the tumor showed solid growth of clear
cells. Prominent hyalinization of the stroma was found. The nature of
the cells was confirmed by positive expression of cytokeratins and
epithelial membrane antigen in epithelial cells and vimentin and
smooth muscle actin in myoepithelial cells. Differential diagnosis of
EMC includes a broad spectrum of salivary gland-type tumors.
Furthermore, metastases of clear cell carcinoma of the kidney or
thyroid, clear cell ("sugar") tumor of the lung, glandular form of
carcinoid, bronchioalveolar adeno- carcinoma with myoepithelial cells
and pulmonary adenosquamous carcinoma with amyloid-like stroma must be
distinguished from EMC. The tumor has neither recurred nor
metastasised, a fact supporting the current opinion, that EMC is a
tumor of low grade malignancy.
Epithelial-myoepithelial
carcinoma of the lung: immunohistochemical and ultrastructural
observations and review of the literature.Hum
Pathol. 1997 May;28(5):631-5.
Epithelial-myoepithelial
carcinoma is a rare low-grade malignant salivary gland neoplasm that
most commonly occurs in the parotid gland but can also arise in minor
salivary glands. We report a case of a primary epithelial-myoepithelial
carcinoma of the lung. The patient is a 55-year-old black woman who
presented with increasing shortness of breath and productive cough of
at least 3 months duration. A left lower lobe endobronchial lesion was
identified radiographically. Surgical resection of the lesion was
performed, obtaining a circumscribed, nonencapsulated 3.9 cm tan mass
which was attached to the inner wall of the lateral basal segment
bronchus. A biphasic proliferation of epithelial (cytokeratin
positive; S-100 protein and muscle-specific actin negative) and
myoepithelial (S-100 protein and muscle-specific actin positive with
focal weak cytokeratin positive) cells was identified by
immunohistochemical and ultrastructural analysis of formalin-fixed
tissue. The patient is disease free 7 months after resection.
Pulmonary epithelial-myoepithelial carcinoma likely derives from the
submucosal bronchial glands and should be added to the growing list of
salivary gland-type neoplasms that may occur as primary pulmonary
neoplasms. Because its histology is identical to salivary epithelial-myoepithelial
carcinoma, pulmonary epithelial-myoepithelial carcinoma should be
considered a low-grade malignant neoplasm and should be designated as
epithelial-myoepithelial carcinoma in preference to other terms that
may not convey its malignant potential. Although follow-up on reported
cases is limited, lobectomy with negative bronchial margin should be
curative.
Epithelial-myoepithelial
tumor of the bronchus. Am J Surg Pathol 1994;18: 421–425.
A primary
bronchial tumor with a histological pattern similar to that of
epithelial-myoepithelial tumor of the salivary gland is reported in a
55-year-old woman. The tumor was well delimited, although not
encapsulated, and showed a polypoid growth. The tumor was composed of
two types of neoplastic cells: epithelial cells displaying tubules and
myoepithelial cells that either formed compact masses or surrounded
the tubular formations. Immunohistochemical study confirmed positive
immunoreaction to both high- and low-molecular-weight cytokeratins in
the epithelial cells and positive immunoreaction to vimentin, S-100
protein, and myosin in the myoepithelial cells.
Epithelial-myoepithelial
tumor of the tracheal gland. J Clin Pathol 1993;46:185–187.
A case of
epithelial myoepithelial tumour originating from the tracheal gland in
a 57 year old woman is described. The tumour was removed by segmental
tracheal resection and end-to-end anastomosis. Histologically, the
tumour comprised clear cells and presented a monophasic pattern.
Immunohistochemical analysis showed that the tumour cells were
positive for both S-100 protein and smooth muscle actin suggesting
that this tumour resembles a subtype of epithelial-myoepithelial
carcinoma described in the 1990 WHO international classification of
salivary glands. Although some reports describe a clear cell dominant
epithelial myoepithelial carcinoma, in this case local invasiveness or
regional lymphnode metastasis was not proved through investigation. It
is therefore concluded that this was an epithelial myoepithelial
tumour rather than a carcinoma.
Pneumocytic
adenomyoepithelioma: a distinctive lung tumor with epithelial,
myoepithelial, and pneumocytic differentiation.Am
J Surg Pathol. 2007 Apr;31(4):562-8.
Pulmonary
tumors with epithelial and myoepithelial differentiation are rare,
thought to be of bronchial minor salivary gland origin and classified
similarly to salivary gland neoplasms. We report a series of a
distinctive subtype of pulmonary glandular tumors showing epithelial
and myoepithelial differentiation with further pneumocytic
specialization. All patients were women, aged 52 to 63 years and
presented with single or multiple pulmonary nodules. The tumors were
grossly circumscribed, 0.8 to 2.6 cm in greatest dimension, and
histologically showed glandular and spindle cell differentiation. Some
glands were filled with colloidlike secretion and had an inner,
cuboidal epithelial cell layer (pankeratin, epithelial membrane
antigen, and thyroid transcription factor-1 positive), surrounded by
an outer layer of myoepithelial cells merging with foci of spindled
myoepithelial cells (high molecular weight keratin, S100, smooth
muscle actin, calponin, caldesmon, and p63 positive). There were also
some glands lined by a single layer of plump cells that were positive
for surfactant protein-A in addition to the other epithelial cell
markers. Electron microscopy confirmed pneumocytic features in these
cells and the myoepithelial nature of the spindled cells. The surgery
in all cases was wedge resection of the masses. The biologic behavior
to date has been benign. This is the first reported series of a
distinctive lung tumor with epithelial, myoepithelial, and pneumocytic
differentiation that differs histologically from all previously
recognized pulmonary salivary gland-type and pneumocytic tumors. It is
a unique benign appearing neoplasm for which the designation
pneumocytic adeno- myoepithelioma is suggested.
|
