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CASE SNIPPET
Year : 2022  |  Volume : 68  |  Issue : 1  |  Page : 53-54

An adult patient with multiple pulmonary mixed squamous cell and glandular papillomas


Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China

Date of Submission16-Sep-2020
Date of Decision09-Oct-2020
Date of Acceptance30-Dec-2020
Date of Web Publication26-May-2021

Correspondence Address:
J Zheng
Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_1079_20

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How to cite this article:
Zhang Y, Lin J, Zhang J, Zheng J. An adult patient with multiple pulmonary mixed squamous cell and glandular papillomas. J Postgrad Med 2022;68:53-4

How to cite this URL:
Zhang Y, Lin J, Zhang J, Zheng J. An adult patient with multiple pulmonary mixed squamous cell and glandular papillomas. J Postgrad Med [serial online] 2022 [cited 2022 Aug 12];68:53-4. Available from: https://www.jpgmonline.com/text.asp?2022/68/1/53/316963




We report a 52-years-old female nonsmoker who had been evaluated earlier at a local hospital for history of recurrent cough. Her chest X-ray was abnormal and a contrast-enhanced computer tomography (CECT) chest examination was done to confirm her condition. Multiple nodules in both lungs were found in CECT scan, and the largest one (diameter of 14 mm) was close to the left pulmonary hilum with enhancement. A bronchoscopy was performed 4 days after the patient's first visit. No abnormality was found by the bronchoscopy and cytological examination. Histology of her trans-bronchial lung biopsy showed bronchiolar hyperplasia and squamous metaplasia. Serum tumor markers, including carcinoembryonic antigen, squamous cell carcinoma antigen, cytokeratin 19 fragment, neuron-specific enolase, and carbohydrate antigen were all within the normal limits.

Subsequently after five months, she visited our hospital for further evaluation. Her vital signs and physical examination were unremarkable. Repeat chest CECT depicted varying-sized nodules in bilateral lungs. Majority of these nodules were solid, but some had a cavity. A well-defined lobulated nodule measuring approximately 14 mm × 12 mm × 15 mm was seen in the left upper lobe and adjacent to the hilus pulmonis [Figure 1]. Other lesions were distributed mainly over the right lower lobe. Compared with her initial CECT chest examination, these nodules showed no significant changes. Radiological opinion considered these pulmonary nodules to be metastatic tumors. For a definitive diagnosis, thoracic surgeon performed wedge resection of two subpleural nodules located in segment 7 and 8 of the right lower lobe. On gross examination, the lesions were well-defined grayish-white solid nodules, measuring 7 mm × 7 mm, and 8 mm × 8 mm in size, respectively. Intraoperative histopathological examination by a frozen section, suggested a diagnosis of mixed squamous cell and glandular papillomas. Histopathological examination of the resected nodules revealed squamous and glandular epithelium. The glandular epithelium consisted of mucinous columnar cells and pseudostratified ciliated or non-ciliated cuboidal cells [Figure 2]. In addition, the squamous epithelium showed varying degrees of atypical hyperplasia. Further immunohistochemical analysis demonstrated the tumor was mostly positive for CK5/6, CK7, CK20, CK (pan), P40, P63, Ki67, and TTF-1. Since the patient refused further treatment a pulmonary lobectomy could not be performed. On follow-up at three months and 12 months these nodules showed no obvious changes on chest CT scans.
Figure 1: (a) Contrast enhanced computed tomography (CECT) scan of chest (axial view) showing solid nodule in segment 10 of right lower lobe (white arrow); (b) solid nodule in segment 8 of right lower lobe (white arrow); (c) lobulated nodule, adjacent to hilus pulmonis, in left upper lobe, (white arrow); (d) CECT scan of chest (coronal view). One-year follow-up CECT scan of chest showing: (e) no / recurrence of any nodule(s) in right lower lobe (white arrows); and (f) unchanged lobulated nodule in left upper lobe

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Figure 2: Mixture of squamous epithelium (white arrow) and glandular epithelium (black arrow). The squamous epithelium showed varying degrees of atypical hyperplasia. The glandular epithelium consisted of mucinous columnar cells and pseudostratified ciliated or non-ciliated cuboidal cells. H & E staining: (a) scale bar 400 μm; (b) scale bar 200 μm

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Solitary endobronchial papillomas (SEPs) are rare neoplasms, accounting for less than 0.5% of all lung tumors.[1] Flieder et al. subdivided SEPs into three separate categories: (i) squamous cell papilloma, (ii) glandular papilloma, and (iii) mixed squamous cell and glandular papilloma (MSGP).[1] Among these three subtypes, MSGP is the rarest kind, accounting for 15.6–20.4% of SEPs, with less than 30 cases reported in the English literature.[2],[3] MSGP is a benign tumor with at least one-third of the tumor comprising the glandular component.[4] To the best of our knowledge, a patient having multiple MSGPs has not been reported earlier. The present case also had multiple MSGPs with a peripheral growth, which challenges the current classification system. Since clinical and radiological manifestations of MSGP are atypical, simply classifying MSGP as a type of SEPs may lead to a case with multiple MSGPs, such as the present one, getting misdiagnosed and also wrongly treated. The present case suggests that MSGP also ought to be classified further into solitary type and multiple type.

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

Financial support and sponsorship

This study was supported by Key Research Foundation of Hwa Mei Hospital, University of Chinese Academy of Sciences, China (Grant No. 2020HMZD19 and No. 2020HMZD20).

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Flieder DB, Koss MN, Nicholson A, Sesterhenn IA, Petras RE, Travis WD. Solitary pulmonary papillomas in adults: A clinicopathologic and in situ hybridization study of 14 cases combined with 27 cases in the literature. Am J Surg Pathol 1998;22:1328-42.  Back to cited text no. 1
    
2.
Tryfon S, Dramba V, Zoglopitis F, Iakovidis D, Sakkas L, Kontakiotis T, et al. Solitary papillomas of the lower airways: Epidemiological, clinical, and therapeutic data during a 22-year period and review of the literature. J Thorac Oncol 2012;7:643-8.  Back to cited text no. 2
    
3.
Inamura K, Kumasaka T, Furuta R, Shimada K, Hiyama N, Furuhata Y, et al. Mixed squamous cell and glandular papilloma of the lung: A case study and literature review. Pathol Int 2011;61:252-8.  Back to cited text no. 3
    
4.
Flieder DB, Nicholson AG, Travis WD, Papillomas YY. In: World Health Organization Classification of Tumors: Pathology and Genetics of Tumors of the Lung, Pleural, Thymus and Heart. Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG, editors. IARC; Lyon: 2015. pp. 106–109.  Back to cited text no. 4
    


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
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