Pulmonary well-differentiated fetal adenocarcinoma diagnosed by bronchial brush and immunocytochemistry

Abstract

A 41-yr-old man with a long history of cigarette smoking presented to his family physician with an intermittent cough of 4-wk duration. Physical examination revealed no remarkable findings. A chest roentgenogram showed a 3-cm mass lesion located near the hilum of his right lung. A chest CT-scan confirmed the lesion to be a well-demarcated and solid tumor located in the lobar bronchus of the right middle lobe. No hilar lymphadenopathy was identified. The patient underwent a bronchoscopy, and a tumor involving the lobar bronchus of the right middle lobe was visualized. A cell sample was obtained by bronchial wash, and the bronchial lesion was brushed two times. Four direct smears prepared from two bronchial brushes and four cytospin smears prepared from the bronchial wash were fixed in 95% ethanol and stained with Papanicolaou method. Two tumor tissue fragments measuring 3 mm in greatest dimension obtained by biopsy were fixed in formalin and processed for routine histologic examination.The bronchial wash was negative for malignant cells. The four smears prepared from two bronchial brushes were cellular and revealed irregular, monolayered sheets of malignant epithelial cells showing clear, ill-defined cytoplasm, slightly pleomorphic, round or oval nuclei and inconspicuous nucleoli. In a few tumor cell groups nuclear crowding and overlapping were noted. The cytologic findings were in keeping with an adenocarcinoma with clear cell change (Fig. 1). However, a pulmonary welldifferentiated fetal adenocarcinoma (WFA) was not ruled out with certainty.Two Papanicolaou-stained smears containing tumor cells were stained with periodic acid-Schiff (PAS) and with PAS with prior diastase digestion (PASD). The tumor cell cytoplasm reacted positively with PAS and negatively with PASD, indicating a nonmucus secreting adenocarcinoma that was rich in glycogen contents. One Papanicolaou-stained smear was stained with commercial chromogranin antibody by the avidin-biotin-complex (ABC) technique without prior destaining. The tumor cells that were present reacted positively with this antibody. The cytologic, cytochemical, and immunocytochemical features of the patient's tumor were in keeping with a pulmonary WFA. The two biopsied tumor tissue fragments showed severe crushing artifacts and were nondiagnostic.The patient's lung tumor was subsequently removed by right pneumonectomy. The resected right lung showed a round, solid malignant tumor arising from the middle lobe lobar bronchus with minimal invasion into the surrounding lung parenchyma. Several tumor tissue blocks were fixed in formalin and processed for histologic, histochemical, and immunohistochemical studies. Histologically, the lung tumor consisted of branching tubules lined by a single layer of columnar epithelial cells with clear cytoplasm, basally located, oval, slightly pleomorphic, hyperchromatic nuclei and inconspicuous nucleoli (Fig. 2). In most tumor cells a large supranuclear cytoplasmic clear vacuole was present. The stroma contained capillary blood vessels and scatt...

Well‐differentiated fetal adenocarcinoma of the lung mimicking adenoid cystic carcinoma on fine needle aspiration: A case report

“…9,18-21 Additionally, there has been noted, in some studies, a focal tigroid background commonly identified at the edge of cellular aggregates. 9,[18][19][20][21] The findings in this case were in agreement with previous reports with respect to the identification of two distinct populations of cells in the presence of abundant stroma. These similar findings can also be suggestive of hamartoma or pleomorphic adenoma, however, this case, did not have the typical epithelial morphology of these latter two diagnoses.…”

“…The cytomorphologic features of WDFA have been reported in a limited number of reports and have shown the presence of a dual population of cells: (1) small cells, uniform in appearance with inconspicuous nucleoli, prominent subnuclear vacuoles and less often supranuclear vacuoles that show an acinar and glandular architecture and (2) larger squamoid cells with prominent nucleoli, dense cytoplasm with morule formation . Additionally, there has been noted, in some studies, a focal tigroid background commonly identified at the edge of cellular aggregates …”

Bronchial brushing cytology of a pulmonary fetal adenocarcinoma with a poorly differentiated component

“…The mean age of patients is in the fourth decade, which is younger than conventional pulmonary adenocarcinoma 1 . Reports of the cytology of FA are very rare, with only six cases of well‐differentiated FA being previously reported in the English literature 1–5 . Therefore, the present case is the first reported example of cytological findings of FA with a poorly differentiated component.…”

“…Although most of FAs are well‐differentiated, a variant designated poorly differentiated FA has been described 6 . A literature review identified six reported cases of well‐differentiated FA sampled by fine needle aspiration or bronchial brushing 1–5 . In these reported cases, smears were composed of clusters arranged in irregular sheets or three‐dimensional structures.…”

Cytomorphology of pulmonary low‐grade fetal adenocarcinoma in bronchial brushing specimen prepared by BD SurePath: A case report and literature review

“…The cytological features of LGFA have rarely been described. A literature review identified 10 reported cases of LGFA sampled by fine needle aspiration or bronchial brushing 9–16 . Table 1 summarizes the clinicopathologic characteristics, cytologic specimen types, and preparation methods of these reported cases and the current case presented in this report 9–16 .…”