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8 July 2015 - Case of the Week #357

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Case of the Week #357

Clinical History:
A 52 year old woman presented with a progressive cough, dyspnea and wheezing. A chest CT scan revealed an endobronchial lesion of the left mainstem bronchus, which was biopsied. The clinical impression was carcinoid tumor or endobronchial neoplasm.

Micro images:

Lung biopsy



What is your diagnosis?































Diagnosis:
Epithelial-myoepithelial carcinoma

Discussion:
Epithelial-myoepithelial carcinoma is a low grade malignancy, very rare in the lung, that arises from submucosal bronchial glands. It mimics the more common salivary gland tumor.

In the lung, the tumor affects men and women ages 40-60 years, and often presents as a bronchial intraluminal polypoid mass which may invade the pulmonary parenchyma (Korean J Thorac Cardiovasc Surg 2014;47:59). Histologically, it is a well circumscribed mass with a pushing margin. It has a distinctive, biphasic proliferation of epithelial and myoepithelial cells with formation of bilayered ductlike structures, with inner epithelial cells and outer clear myoepithelial cells (Case Rep Pathol 2012;2012:319434). There is no myxoid or chondroid stroma and no perineural invasion (Hum Pathol 2009;40:366). The epithelial cells are immunoreactive for cytokeratin and EMA, but negative for S100 and HMB45. The myoepithelial cells are immunoreactive for S100 and MSA, and may be weakly positive for keratin. In this case, immunostains were not performed.

The differential diagnosis includes other salivary gland tumors, including acinic cell carcinoma, adenoid cystic carcinoma with a tubular pattern, mucoepidermoid carcinoma and pleomorphic adenoma, as well as metastases to the lung (Eur Arch Otorhinolaryngol 2006;263:1158).

Excision is usually curative, although recurrence and metastasis have been reported (Lung Cancer 2014;83:416, J Thorac Oncol 2013;8:1578, Case Rep Oncol Med 2011;2011:610383).


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