A rare pulmonary benign bi-phasic tumor: a case report of pulmonary adenofibroma and literature review / 北京大学学报(医学版)

ABSTRACT

Pulmonary adenofibroma is an extremely rare benign primary tumor of the lung,with characteristic bi-phasic differential pattern.They are usually sub-pleural solid pulmonary nodules with clear margins.The tumor is composed of glands and peri-gland stroma.The glands are often quite simple,forming long and narrow tubules,with uniformly monolayer lining cells.Combined papillary or phyllodes structures were reported in some cases.The stromal cells are spindle-shaped and look mild,mixed with the collagen bands.Up till now,only a few cases of pulmonary adenofibroma have been reported all over the world.And because of the limited recognition,this tumor is easily misinterpreted as malignancy in frozen section or biopsy specimens.We reported a new case of pulmonary adenofibroma.The mass peripherally located in the left lobe of the lung,found by chance in a 74-year-old woman.The patient underwent a wedge resection of the left lung by the thoracoscope,because of the slowly gradual enlargement of the mass annually.An oval grayish-white nodule was sub-pleural located in the specimen,with solid and rubbery texture,but without a distinct capsule.Two distinct components of simple glands and mild spindle cell stroma were found to mix together uniformly under the microscope.Collagen bands of various widths evenly surrounded each stromal cell.A few small coarse papillae or phyllodes structures were randomly distributed in some area.The immunohistochemical staining pattern of the glandular cells was accordant with type Ⅱ alveolar epithelium.Stromal cells were positive with CD34,B-cell lymphoma-2 (Bcl-2),CD99and estrogen receptor (ER),while S-100,smooth muscle actin (SMA) and all the mesothelium markers were negative.The patient was disease free after the surgery,although the follow-up time was only one year.Besides the new case above,we also reviewed all the reported cases,and tentatively discussed the probable histological origin of pulmonary adenofibroma.