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      A diagnostic challenge: An incidental lung nodule in a 48-year-old nonsmoker

      case-report

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          Abstract

          A 43-year-old female with a medical history of renal stones, hypertension, diabetes mellitus Type 2, and depression presented to her urologist with bilateral flank pain. She complained of worsening exertional dyspnea over the last several months with recent weight gain. She also endorsed night sweats and intermittent, scant hemoptysis over the past year. She denied fever, chills, nausea, vomiting, diarrhea, constipation, hematuria, or excessive joint or muscle pain. Physical examination was unremarkable. Computed tomography scan of abdomen and pelvis demonstrated bilateral nonobstructing renal stones and a 1.8 cm × 1.7 cm nodular opacity in the right lower lobe of the lung, not present on previous scan 1 year prior. Surgical wedge resection was performed and subsequent pathologic examination demonstrated a 1.2 cm × 0.6 cm × 0.5 cm soft, gelatinous well-demarcated mass in the right lower lobe wedge specimen without gross evidence of necrosis or hemorrhage confirming colloid adenocarcinoma of the lung.

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          FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features.

          Dave K Berger, Rhonda Nicholson, F Dehdashti … (2000)
          Our goal was to assess the sensitivity of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) for the detection of mucinous carcinoma and to determine the histologic features of these tumors that may affect lesion detectability. A retrospective review of all patients with mucinous carcinoma who had undergone FDG PET at our institution from 1995 through 1998 identified 25 patients with new or recurrent mucinous carcinoma at the time of PET. In 22 of these patients, tissue specimens available from either core biopsy or surgical resection allowed detailed histologic analysis. FDG PET revealed mucinous carcinoma in only 13 (59%) of 22 patients, resulting in an unusually high percentage (41%) of false-negative results. Two histologic features were found to be predictive of FDG PET results: tumor cellularity (p = 0.011) and the amount of mucin within the tumor mass (p = 0.009). There was a positive correlation between tumor FDG uptake and cellularity but a negative correlation with the amount of mucin. FDG PET is limited in the evaluation of mucinous tumors, particularly in hypocellular lesions with abundant mucin.
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            Determining the site of origin of mucinous adenocarcinoma: an immunohistochemical study of 175 cases.

            Sarah Chu, Mark L. Weiss, S. Lau … (2011)
            Mucinous adenocarcinomas (MAs) of various origins may have a similar histologic appearance and frequently metastasize to distant sites, which often causes diagnostic problems in surgical pathology practice. The immunohistochemical profiles of MAs of various origins have not been well studied. We investigated the expression of 10 immunohistochemical markers (CK7, CK20, CDX-2, β-catenin, MUC-1, MUC-2, MUC-6, ER, WT-1, and PAX-8) in 175 cases of MA, including 69 cases from the lower gastrointestinal (GI) tract, 41 from the upper GI tract, 27 from gynecologic organs, 4 from the urinary bladder, 18 from the breast, and 16 from the lung. We found that lower GI MAs (colon, rectum, and anus) frequently expressed CDX-2 (42 of 42, 100%; 33 of 42 with homogenous positivity, 79%), MUC-2 (42 of 42; 100%), CK20 (41 of 42; 98%), and β-catenin (nuclear) (27 of 42; 64%) and rarely expressed MUC-6 (2 of 42; 5%) and CK7 (8 of 42; 19%). Most of the CK7-positive cases were from the rectum and anus (7 of 8; 88%). The expression of these markers in appendiceal MAs was similar to that of low GI tract MAs, except for a lower percentage of homogenous CDX-2 (3 of 27; 11%) and nuclear β-catenin (3 of 27; 11%) expression. Unlike their lower GI tract counterparts, the upper GI tract MAs (ampulla, pancreas/biliary tree, and stomach/esophagus) frequently expressed CK7 (38 of 41; 93%) and MUC-6 (31 of 41; 76%) and were rarely homogenously positive for CDX-2 (4 of 41; 10%) and nuclear positive for β-catenin (8 of 41; 19%). Breast MAs were frequently positive for CK7 (18 of 18; 100%), MUC-1 (18 of 18; 100%), MUC-2 (18 of 18; 100%), ER (16 of 18; 89%), MUC-6 (9 of 18; 50%), and WT-1 (9 of 18; 50%). Lung MAs were frequently positive for CK7 (16 of 16; 100%) and MUC-1 (15 of 16; 94%). Gynecologic MAs were positive for CK7 (25 of 27; 93%) and PAX-8 (13 of 27; 48%). We conclude that homogenous CDX-2 and nuclear β-catenin expressions are commonly seen in lower GI tract MAs. In contrast, appendiceal MAs are usually heterogenously positive for CDX-2 and show cytoplasmic positivity for β-catenin. Unlike lower GI tract MAs, upper GI tract MAs are frequently positive for CK7 and MUC-6. As is the case in appendiceal MAs, the upper GI tract MAs may also be heterogenously positive for CDX-2. Breast MAs are positive for ER and WT-1, whereas gynecologic MAs are positive for PAX-8 and negative for WT-1.
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              The spectrum of pulmonary mucinous cystic neoplasia : a clinicopathologic and immunohistochemical study of ten cases and review of literature.

              S Urbanski, Chun-hua Gao (2005)
              We describe 10 new cases and review 66 previously reported cases of primary pulmonary mucinous cystic neoplasia (PMCN). The 3 men and 7 women were 44 to 73 years old (mean, 60.0 years) at diagnosis. Lesions were found by chest radiograph (featuring a solitary, lobulated nodule with soft tissue density that enlarged slowly), or patients had major bronchial occlusion by mucus or hemoptysis. Tumors were well-circumscribed, lobulated soft masses with a central cavity filled with gray to greenish translucent mucus and were 1.5 to 5.5 cm in greatest dimension (mean, 3.3 cm). Microscopically, confluent lakes of mucin characterized all cases. Tumor epithelium ranged from bland to focal cytologic atypia to frankly malignant. The adjacent lung parenchyma was stretched, compressed, or showed an inflammatory reaction to dissected mucin. After 1- to 10-year follow-up (mean, 3.7 years), 3 patients died of metastasis and 1 of amitriptyline toxic effects; 6 were alive without tumor. Combined analysis of our cases and previously reported cases suggests a histologic spectrum from benign cystadenoma to mucinous cystic tumor with atypia to well-differentiated mucinous cystadenocarcinoma. The histomorphologic criteria derived from this analysis can help distinguish PMCN from other types of primary or metastatic mucinous tumors and predict outcome.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Lung India
                Journal ID (iso-abbrev): Lung India
                Journal ID (publisher-id): LI
                Title: Lung India : Official Organ of Indian Chest Society
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0970-2113
                ISSN (Electronic): 0974-598X
                Publication date (Print): May-Jun 2018
                Volume: 35
                Issue: 3
                Pages: 251-255
                Affiliations
                [1] Medical College of Georgia, Augusta, GA, USA
                [1 ] Department of Radiology, Medical College of Georgia, Augusta, GA, USA
                [2 ] Department of Pathology, Medical College of Georgia, Augusta, GA, USA
                Author notes
                Address for correspondence: Dr. Helena Spartz, 1103 Peachtree Road, Augusta, GA 30909, USA. E-mail: HSpartz@ 123456augusta.edu
                Article
                Publisher ID: LI-35-251
                DOI: 10.4103/lungindia.lungindia_212_17
                PMC ID: 5946561
                PubMed ID: 29697085
                SO-VID: d082285d-e41f-4a70-b9bb-bdecbda2878f
                Copyright © Copyright: © 2018 Indian Chest Society
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Respiratory medicine
                Keywords: colloid adenocarcinoma of the lung,lung nodule,mucinous adenocarcinoma
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: colloid adenocarcinoma of the lung, lung nodule, mucinous adenocarcinoma

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