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LETTER TO EDITOR  
Year : 2018  |  Volume : 61  |  Issue : 4  |  Page : 634-636
Primary pulmonary pleomorphic adenoma: A rare case report


Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India

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Date of Web Publication10-Oct-2018
 

How to cite this article:
Raphael V, Gogoi BB, Mishra J. Primary pulmonary pleomorphic adenoma: A rare case report. Indian J Pathol Microbiol 2018;61:634-6

How to cite this URL:
Raphael V, Gogoi BB, Mishra J. Primary pulmonary pleomorphic adenoma: A rare case report. Indian J Pathol Microbiol [serial online] 2018 [cited 2018 Dec 15];61:634-6. Available from: http://www.ijpmonline.org/text.asp?2018/61/4/634/243005




Sir,

Primary pulmonary pleomorphic adenoma is a rare tumor with less than 15 cases reported in the literature till date, with no reference being found in Indian literature.[1] It has been reported in individuals ranging from 11 to 74 years, but most often affects those in their sixth and seventh decades of life with no gender predilection.[2] We present a case of a 32-year-old male with primary pulmonary pleomorphic adenoma.

The patient presented with complaints of recurrent fever associated with cough and expectoration for duration of 4 years. On X-ray examination, a well-defined opaque mass was detected in the lower lobe of right lung [Figure 1]a. Other laboratory parameters are within the normal limits. Subsequently, the patient underwent thoracotomy and right lower lobectomy.
Figure 1: (a) Preoperative X-ray showing mass in the lower lobe of right lung. (b) Right lower lobectomy specimen showing the tumor

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On gross examination of the resected specimen, a well-circumscribed mass in the lateral basal bronchopulmonary segment was noted, measuring 3 cm × 3 cm × 3 cm [Figure 1]b. The mass was intraparenchymal with no involvement of the endobronchial tree. On cut-section, the mass was solid, fleshy, gray white, with areas showing mucoid to glistening appearance. There was no area of necrosis or hemorrhage. No gross pathology was noted in the surrounding lung tissue.

On microscopic examination, the tumor was well-circumscribed, though there was no well-defined capsule. The tumor mass showed features consistent with pleomorphic adenoma. Surrounding lung parenchyma shows features of nonspecific inflammation with pneumonitis [Figure 2].
Figure 2: Pulmonary pleomorphic adenoma: microscopic findings. (a) Tumor with surrounding normal lung tissue [hematoxylin and eosin (H and E), ×40]. (b) Epithelial cells arranged in the form of tubules and chords surrounded by mantle of myoepithelial cells (H and E, ×100). (c) Chondromyxoid background (H and E, ×100). (d) Chondroid area (H and E, ×200)

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Pleomorphic adenoma is the most common neoplasm of the salivary glands. It can occur in other sites, such as palate, tongue, nasopharynx, larynx, skin, breast, and soft tissue. Lung is an unusual site for pleomorphic adenoma. Even in those cases arising from the lung, it is more common inside the main bronchi rather than the lung parenchyma.[3],[4] The pulmonary tumors have a relative paucity or absence of duct-like structures in the epithelial component in comparison to their counterparts in the salivary glands. The epithelial elements in such cases are mostly arranged in strands, slender cords, and islands of tumor cells.[5]

The differential diagnosis to be considered here are hamartoma, pulmonary blastoma, and carcinosarcoma. In hamartoma, the chondroid elements are well developed and are sharply demarcated from the epithelial component, rather than being an integral part of the lesion. Pulmonary blastoma and carcinosarcoma will consist of malignant stroma and epithelium.[2],[5]

Small and well-circumscribed lesions are usually curable with lobectomy, while larger, poorly circumscribed lesions have tendency for recurrence and metastasis. High mitotic count (>5/10 hpf) may be associated with aggressive behavior, but in the absence of malignant cytology, angiolymphatic invasion, and necrosis such lesions should be diagnosed as benign pleomorphic adenoma rather than carcinoma ex-pleomorphic adenoma.[2] However, a long-term follow-up is recommended due to the possibility of malignant behavior.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Jin HY, Park TS. Pulmonary pleomorphic adenoma: Report of a rare case. Korean J Intern Med 2007;22:122-4.  Back to cited text no. 1
    
2.
Flieder DB, Thivolet-Bejui F, Popper H, Moran C. Pleomorphic adenoma. In: Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC, editors. WHO pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004. p. 86.  Back to cited text no. 2
    
3.
Fitchett J, Luckraz H, Gibbs A, O'Keefe P. A rare case of primary pleomorphic adenoma in main bronchus. Ann Thorac Surg 2008;8:102 5-6.  Back to cited text no. 3
    
4.
Ali SR, Arrossi AV, Mehta AC, Frye L, Mazzone P, Almeida F. Endobronchial pleomorphic adenoma. Oxf Med Case Reports 2016;12:300-1.  Back to cited text no. 4
    
5.
Moran CA, Suster S, Askin FB, Koss MN. Benign and malignant salivary gland-type mixed tumor of the lung: clinicopathologic and immunohistochemical study of eight cases. Cancer 1994;73:2481-90.  Back to cited text no. 5
    

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Correspondence Address:
Bidyut B Gogoi
Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_73_18

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