Extensive goblet cell metaplasia of the peripheral lung may harbor precancerous molecular changes: Comparison of two cases

Abstract

We present two cases of extensive goblet cell metaplasia in the peripheral lung. The first case was a 72-year-old male with a nodule (12 × 10 mm) detected by CT. Macroscopically, it contained abundant mucin; histopathologically, goblet cells were predominant, whereas ciliated and basal cells were sparse. A KRAS G12V mutation was detected. In the pulmonary background of this case, scattered tiny foci of goblet cell metaplasia were present. The second case was a 71-year-old female with a nodule (7 × 5 mm) detected by CT. It contained abundant mucin, and microscopically, various cell types were intermingled. Although the nodule mainly comprised goblet cells, ciliated and basal cells were also easily identified. No KRAS mutation was found in this patient. Dispersed minute foci of goblet cell metaplasia were identified in the pulmonary background. Therefore, we suspect that airway irritants may have contributed to the changes that occurred in the pulmonary background of both cases. We propose that the tendency of goblet cells to overwhelm other cell types in the metaplastic epithelium may be an indicator of precancerous molecular changes.

Alveolar progenitor cells and the origin of lung cancer

“…Higher levels of specific mucins, such as MUC1, have been related to increased aggressiveness in LUAD [22]. However, LUAD composed of goblet cells is relatively rare [23,24]. The region between the airways and the alveolar space, the bronchioalveolar duct junction (BADJ), contains bronchioalveolar stem cells (BASCs) that can give rise to both airway and alveolar cells [25,26].…”

Opposing roles for TGFβ- and BMP-signaling during nascent alveolar differentiation in the developing human lung

“…Thus, the AT2-like to goblet-like transition observed here seems distinct from what has been reported in IPF patients, where basal cells are present. Never-the-less goblet cell metaplasia is associated with IPF and other lung diseases including chronic obstructive pulmonary disorder (COPD), pulmonary infections and cancer 88 – 92 , making the AT2-to-goblet cell fate transition observed here worthy of deeper investigation.…”