Primary salivary gland-type tumours of the lung (PSGT) are very rare and constitute less than 1% of all primary lung tumours and commonest subtype of PSGT is pulmonary mucoepidermoid carcinoma (PMEC). We present such a case in 28-year-old male with history of fever, haemoptysis and dyspnoea, he had gross pallor, thin built and his x-ray showed opacity in left lower zone. His CECT chest showed endobronchial mass and PET-CT was suggestive of bronchial carcinoid. Final diagnosis of PSGT was confirmed with help of histopathology and immuno-histochemistry. We aim to emphasize the importance of this rare tumour as close differential of carcinoid tumour

Aneeta Singh

Avinash Rajra

KC Goswami

Shalija Kotwal

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JK SCIENCEVol. 27 No. 1, Jan - March 2025                  JK Science: Journal of Medical Education & Research 57CASE REPORTAbstractPrimary salivary gland-type tumours of the lung (PSGT) are very rare and constitute less than 1% of allprimary lung tumours and commonest subtype of PSGT is pulmonary mucoepidermoid carcinoma (PMEC).We present such a case in 28-year-old male with history of fever, haemoptysis and dyspnoea, he had grosspallor, thin built and his x-ray showed opacity in left lower zone. His CECT chest showed endobronchialmass and PET-CT was suggestive of bronchial carcinoid. Final diagnosis of PSGT was confirmed withhelp of histopathology and immuno-histochemistry. We aim to emphasize the importance of this raretumour as close differential of carcinoid tumour.Key WordsMucoepidermoid, Lung Mass, Salivary Gland, Carcinoid tumour.Unveiling Rarity: A Case Report on MucoepidermoidCarcinoma of LungAneeta Singh, KC Goswami, Shalija Kotwal, Avinash RajraDepartment of Pathology, ASCOMS & Hospital, Sidhra, Jammu, IndiaCorrespondence to: Dr Shalija Kotwal, Assistant Professor, Department of Pa-thology, ASCOMS, Sidhra, Jammu, IndiaManuscript Received: 16.04.2024; Revision Accepted: 28.06.2024;Published Online First: 10 Jan, 2025Open Access at: https://journal.jkscience.orgCopyright: © 2025 JK Science. This is an open access journal, and articles are distributedunder the terms of the Creative Commons Attribution-NonCommercial-Share Alike4.0 International License, which allows others to remix, transform, and build upon thework, and to copy and redistribute the material in any medium or format non-commercially, provided the original author(s) and source are credited and the newcreations are distributed under the same license.Cite this article as: Singh A, Goswami KC, Kotwal S, Rajra A. Unveiling Rarity:A Case Report on Mucoepidermoid Carcinoma of Lung. JK Science 2025;27(1):57-59  pISSN: 0972-1177IntroductionWe present a young male with prolonged fever withhaemoptysis turning out to have PMEC, lung.Case ReportA young 28-year-oldmale daily wager, presented withfever and haemoptysis for one month. Patient had historyof grade III dyspnoea, weight loss and poorappetite. Onthorough physical examination he had thin built, grosspallor. His pulse and B. P were normal. His hemoglobinwas 8.0 gm/dl while other biochemical parameters werenormal. His chest x-ray (CXR) demonstrated diffuseopacity in the left lower zone of lung. CECT Chestshowed endobronchial mass lesion in left lower lobebronchus with complete atelectasis of left lower lobe withmucoid bronchogram giving impression of bronchialcarcinoid tumor and PET-CT showed a soft tissue densitynodular lesion in left lobe bronchus. Bronchial biopsyshowed histopathological features of poorly differentiatedMucoepidermoid carcinoma (MEC) is a type ofcarcinoma most frequently seen in parotid andsubmandibular salivary glands and rarely can also arisefrom minor salivary glands of the oral cavity andpremaxillaryarea. According to the World HealthOrganization’s (WHO) lung tumor classification, primarysalivary gland-type tumors of the lung (PSGT) are veryrare and constitute less than1% of all primary lungtumors.[1,2] The most common subtype of PSGT ispulmonary mucoepidermoid carcinoma (PMEC) whichis malignant salivary gland type tumor mainly consists ofmucin-secreting cells, squamoid cells, and intermediate-type cells.PMEC was first reported by Smetana et al. in 1952[3]and  is believed to have origin from the minor salivaryglands lining the tracheobronchial tree.Low grade tumorshave excellent results as they can be completely resected.JK SCIENCE58  JK Science: Journal of Medical Education & Research                  Vol. 27 No. 1, Jan - March 2025squamous cell carcinoma. Pneumonectomy of left lungwas done and tissue specimen was sent forhistopathological examination to the department ofpathology of our hospital.On cut section, unifocal, a wellcircumscribed whitish firm growth measuring 3.5X2.5X2cm was identified in left lobe bronchus (Fig.1).Microscopy sections revealed tumor characterized bycombination of mucous secreting, squamous andintermediate cell type. There was presence of glandularelements, mucin secreting cells and nests of squamoidand intermediate cells. The degree of nuclearpleomorphism was mild and significant number of mitoticfigures were also present. Histological grade wasintermediate.No lympho vascular invasion and perineuralinvasion was identified. Pleural, bronchial and vascularmargins were free of tumor. Lymph nodes were alsofree of tumor. Pathological staging was pT1cpN0 (Fig.no. 2a, & 2b).On immunostaining, glandular structures were positivefor CK7 and negative for TTF1, P40, P63, Napsin,Synaptophysin and Chromogranin.DiscussionThough PMEC is sporadic, it is of great clinicalsignificance because of its potential for aggressivebehaviour and variable prognosis. The tumor arises frombronchial glands in the central airways, particularly in themain bronchi and trachea, and a combination of wheezing,cough, haemoptysis and dyspnoea are the most commonsymptom. Histologically, the pattern of proliferation ofcells in MEC is cystic or cystic papillary. They may begraded into low, intermediate or high-grade malignancybased on five parameters: (i) proportion of cystic andsolid elements, (ii) neural invasion, (iii) necrosis, (iv)anaplasia and (v) mitotic rate.[4] The low-grade tumorscan have a long natural history and rarely metastasize,while the high-grade tumors can be very aggressive andprone to local invasion and early metastasis.[5] Diagnosisof this entity is generally made on histological featuresdue to lack of precise clinical and imaging features. PMECmust be differentiated from adenosquamous carcinomaespecially in tiny biopsy specimens obtained throughfibreoptic bronchoscopy or lung puncture.Mucoepidermoid carcinoma of a lung has got diversehistological composition, ranging from mucin secretingcells to squamous and intermediate cells. The diagnosisFig 2(b) Sections from hematoxylin and eosin stain 40xshowing predominance of intermediate cell (arrow)andglandular structures.Fig 2(a) Microscopic findings of tumour section fromhaematoxylin-eosin stain (x 20) showing areas of glandformation along with mucoid cells, squamoid cells andintermediate cells.Fig 1. Gross feature:Pneumonectomy specimen of left lungshowing unifocal, well circumscribed whitish firm mass inleft lower lobe bronchus.JK SCIENCEVol. 27 No. 1, Jan - March 2025                  JK Science: Journal of Medical Education & Research 59References1. Kumar V, Soni P, Garg M, Goyal A, Meghal T, Kamholz S.Abhinav et al.A comparative study of primary adenoid cysticand Mucoepidermoid carcinoma of lung. Front Oncol 2018;5(18):153. 2. The WHO Classification of tumours editorial board. WorldHealth Organization classification of tumours. ThoracicTumours. Lyon: IARC Press; 2020. pp. 121–2.3. Smetana HF, Iverson L, Swan LL. Bronchogenic carcinoma;an analysis of 100 autopsy cases. Mil Surg 1952; 111(5):335-51.4. Priyadharshini E. Mucoepidermoid carcinoma of hard palateparipex. Indian J Res 2016; 5:394–5.5. Ishikawa Y, Alvarez-Fernandez E, Aubry MC, Dacic S,Nicholson AG. Mucoepidermoid carcinoma In: Travis WD,Brambilla E, Burke AP, Marx A, Nicholson AG,(editors). WHO classification of tumours of the lung, pleura,thymus and heart. Lyon: IARC Press; 2015. pp. 99–100.6. Ruzich JC, Ciesla MC, Clark JI. Response to paclitaxel andcarboplatin in metastatic salivary gland cancer: a case report.Head Neck 2002;24: 406–10.7. Travis WD, Brambilla E, Muller-Hermelink HK. WHOClassification Tumor of the Lung, Pleural, Thymus and Heart.Lyon: World Health Organization 2004;63–48. Heitmiller RF, Mathisen DJ, Ferry JA. Mucoepidermoid lungtumors. Ann Thorac Surg 1989;47:394.of MEC is sometimes challenging. According to theWHO Classification, criteria more typical of high-grademucoepidermoid tumors include: (i) exophyticendobronchial growth, (ii) surface epithelium lackingchanges of in situ carcinoma, (iii) absence of individualcell keratinization and squamous pearl formation and (iv)transitional area to low-grade MEC.[6] Ours case was ofintermediate grade.15 cases were reported to be low grade and 3 werehighgrade type tumors in one series on MEC.All low-grade tumors that had been resected were alive at thelast follow-up (the mean follow-up period was 4.7 years)while all three high-grade tumors were fatal within 16months.[7]Complete surgical resection and lymph node dissectionhave been considered critical for long-term survival inpatients with PMEC in some studies. Some authors havedescribed that patientwith positive lymph node metastases,positive tumor margins, or patients with a high-grade typeshould undergo postoperative chemotherapy.[8]ConclusionWe describedan intermediate grade of PMEClung whopresented with fever, haemoptysis and dyspnoea, waspresumably diagnosed as poorly differentiated squamouscell carcinoma lung on bronchial biopsy, but afterhistopathological examination of pneumonectomyspecimen and IHC,it turned out to be PMEC, lung.Financial Support and Sponsorship: NilConflict of Intrest : Nil

Unveiling Rarity: A Case Report on Mucoepidermoid Carcinoma of Lung

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Unveiling Rarity: A Case Report on Mucoepidermoid Carcinoma of Lung

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