Unique case of pulmonary bronchial gland type tumor with broad spectrum of cell differentiation from the terminal duct–acinar unit to excretory duct

Abstract

In the lung, acinic cell carcinoma (ACC) is a rare form of tumor. Reported herein is a unique bronchial gland-type tumor diagnosed as well-differentiated ACC that developed in the B9 bronchus of the left lung. Various immunohistochemical and histochemical staining partly satisfied the diagnosis of ACC. Moreover, this tumor contained various sizes of mucous cysts lined by columnar mucous cells, which produced abundant mucin positive for Alcian blue, which is usually present in mucoepidermoid carcinoma. Therefore, the present case is a unique tumor having a broad spectrum of cell differentiation from the terminal duct--acinar unit to the striated duct and excretory duct. This is the first case of unique bronchial gland-type tumor with mixed histological features of ACC and mucoepidermoid carcinoma.

Primary acinic cell carcinoma of the trachea: A case report and literature review

“…[5] To the best of our knowledge, including the present case, only 32 patients with primary ACC of the lung or trachea have been reported so far. [5–26] Clinicopathological features of the patients are summarized in Table 1. The most common symptoms were hemoptysis and coughing, but 1-third (11/32) of the patients were asymptomatic and the tumor was identified incidentally.…”

“…The most common symptoms were hemoptysis and coughing, but 1-third (11/32) of the patients were asymptomatic and the tumor was identified incidentally. [5–26] Of the patients with primary ACC of the lungs, 14 were female and 17 were male. The patient age varied widely between 4 to 75 years (mean age: 43.4 years).…”

“…Symptoms Yr Sex Age Size (cm) Site Therapy Outcome 1 [5] Asymptomatic 1972 M 63 4.2 RLL S A, 22 mo 2 [6] Recurrent pulmonary infections 1976 F 12 0.8 RML, bronchus intermedius S A, 1 yr 3 [7] Three-year history of hemoptysis 1982 M 54 2.2 Trachea S A, 2 yr 4 [8] Persistent cough 1985 M 36 4 RML Unknown Unknown 5 [9] Incidental 1992 F 44 3.5 RML, subpleural S A, 10 yr 6 [9] Incidental 1992 F 48 4 LUL, parenchymal S LF 7 [9] Incidental 1992 F 50 1.7 RML, subpleural S A, 3 yr 8 [9] Persistent cough 1992 M 63 1.2 RML, endobronchial S A, 4 yr 9 [9] Incidental 1992 F 75 1.5 RUL, subpleural S A, 4 yr 10 [10] Dyspnea, cough, stridor 1994 M 31 2 Trachea S A, 8 yr 11 [11] Hemoptysis 1996 M 59 3 Trachea S ND 12 [12] Incidental 1999 M 64 3 LLL, endobronchial S, radiation A, 1.5 yr 13 [13] Incidental 2003 F 30 2 RLL, subpleural S R, 20 mo 14 [14] Incidental 2003 M 70 4 RLL, intraparenchymal S ND 15 [15] Hemoptysis and night sweats 2004 F 4 3 LUL, endobronchial S ND 16 [16] Hoarseness 2004 M 54 5 Trachea S A, 23 mo 17 [17] Persistent cough 2004 M 58 1.5 RML, endobronchial S A, 4 mo 18 [18] Incidental 2005 F 37 3.3 RUL S ND 19 [19] Incidental 2006 M 47 1.8 LLL, endobronchial S A, 1 yr 20 [20] Asymptomatic 2010 M 68 1.8 LLL S, chemotherapy ND 21 [21] Incidental 2011 M 63 5.2 RUL S A 22 [22] Persistent cough 2011 F 55 1.3 RUL S, chemotherapy A, 3 yr 23 [23] Persistent cough 2017 M 31 4.5 RLL, subpleural S ND 24 [24] Persistent cough, hemoptysis 2019 F 10 1.5 LUL S A, 30 mo 25 [24] Persistent cough, chest pain 2019 M 25 2.2 RUL S A, 48 mo 26 [24] Hemoptysis 2019 M 37 1 RLL S A, 8 mo 27 [24] Persistent cough, hemoptysis 2019 F 8 0.4 LML S A, 33 mo 28 [24] Persistent cough, hemoptysis 2019 M 28 1 RML S A, 31 mo 29 [24] Hemoptysis 2019 F 53 1.5 RML S A, 28 mo 30 [25] Persistent cough, hemoptysis 2021 F 27 8.6 RUL, endobronchial S A, 24 mo 31 [26] Persistent…”

Recent developments in the pathology of primary pulmonary salivary gland‐type tumours

“…[16][17][18][19] Most cases exhibit a clear-cell component, and some cases show rare mucous cells. 18,161 Certain features of pulmonary AciCC differ from those of head and neck and breast AciCC (Table 4). The latter may represent a variant of triple-negative breast carcinoma rather than a true salivary glandtype tumour, given differences in its histomorphologic and molecular features, 163 raising the question of whether pulmonary AciCC would also be better classified as a variant of pulmonary adenocarcinoma rather than a salivary gland-type tumour.…”

“…Lysozyme, amylase, and alpha-1 antitrypsin/ chymotrypsin had greater than 90% sensitivity for breast AciCC, 171,172 but these markers had variable staining or were negative in head and neck AciCC. [173][174][175] Among pulmonary AciCC, six out of eight carcinomas expressed alpha-1 antitrypsin/ chymotrypsin, 16,19,159,161 one out of five was positive for amylase, 159 and none of the seven cases expressed lysozyme. 18,47,159 Most head and neck AciCC have translocations resulting in upregulation of NR4A3 expression, 177 resulting in positive NR4A3 immunohistochemistry in most cases.…”