Peripheral pulmonary papillary adenocarcinoma with prominent cilia: report of a rare case that was difficult to diagnose preoperatively.

BACKGROUND: In pulmonary cytology, the existence of cilia is considered cytologic evidence of benign cells because it is generally considered that cilia could not be identified by light microscopic observation of pulmonary adenocarcinoma. However, we encountered a rare exceptional case of pulmonary adenocarcinoma with cilia. CASE: A 55-year-old woman with bloody sputum was admitted. Computed tomography revealed a lung tumor. Although transbronchial brushing cytology showed atypical cells suggestive of malignancy, some atypical cells had cilia, so we could not diagnose them as cancer cells. After antibiotic therapy, the tumor was surgically excised. Imprint cytology showed similar atypical ciliated cells. Histologically, the tumor was diagnosed as papillary adenocarcinoma with cilia and diffuse pleural dissemination was observed. Electron microscopic observation identified cilia. The patient died due to aggravation of cancer, which was confirmed on autopsy. CONCLUSION: This rare case of peripheral pulmonary papillary adenocarcinoma with cilia could not be diagnosed as cancer cell on cytology. Pulmonary papillary adenocarcinoma with cilia should be considered in the differential diagnosis of atypical cells in pulmonary cytology.

Combined analysis of cyclooxygenase-2 expression with p53 and Ki-67 in nonsmall cell lung cancer.

BACKGROUND: Cyclooxygenase-2 (COX-2) is known to play a role in carcinogenesis and tumor progression. The aim of this study was to evaluate the relationship between COX-2 expression and clinicopathologic features, and to define the importance of COX-2 expression alone and in combination with p53 and Ki-67 expression in the clinical outcome of NSCLC. METHODS: A total of 219 patients with stage I-IIIB nonsmall cell lung cancer (NSCLC) who previously underwent surgery were analyzed in this study. The COX-2 expression was evaluated by means of immunohistochemistry; p53 and Ki-67 immunoreactivity were also studied. RESULTS: The COX-2 expression was observed in 137 patients (63%) and was significantly associated with lymph node metastasis and the histological grade of those with adenocarcinoma (p = 0.02 and 0.04, respectively). Kaplan-Meier analyses revealed that COX-2 expression was correlated with poor survival (p = 0.005), whereas multivariate survival analysis did not reveal COX-2 expression to be an independent prognostic factor. When the patients were stratified according to gender, age, tumor histology, and disease stage, COX-2 expression was significantly associated with unfavorable prognosis in males, younger patients (< or = 65 years), and those with adenocarcinoma and stage I tumors. The prognosis of patients with tumors negative for both COX-2 and p53 expression was significantly favorable, whereas those with tumors positive for COX-2 expression and with a high Ki-67 labeling index had a significantly unfavorable prognosis. CONCLUSIONS: These findings indicate that combined immunohistochemical analysis of COX-2 with p53 and Ki-67 can be useful for identifying the prognosis of NSCLC patients.