Solitary peripheral ciliated glandular papillomas of the lung: a report of 3 cases.

We report 3 cases of solitary papillomas located in peripheral regions of the lung that are extremely rare in the literature. The patients were 75-year-old and 72-year-old men and a 53-year-old woman. One patient complained of recurrent hemoptysis. The other 2 had no symptoms, but abnormal nodular shadows were revealed by chest radiographs during a health check. The maximum diameters of the tumors were 1.0, 1.4, and 1.1 cm, respectively. The 3 tumors gave almost the same histologic findings. Papillomatous fronds lined by a stratified columnar epithelium were seen in the lumens of peripheral bronchi, bronchioles, or alveoli. The stratified columnar epithelium consisted of ciliated, mucous, and basal cells. The neoplastic epithelium extended to the alveolar region and showed a similar appearance to bronchioloalveolar or papillary type adenocarcinomas. For differential diagnosis, it is noteworthy that endobronchiolar papillomatous fronds constantly exist and spreading along alveolar walls is limited in adjacent alveoli in peripheral papillomas. The presence of ciliated cells and basal cells is considered an important finding to suggest benign character of the lesion.

In vivo imaging of the bronchial wall microstructure using fibered confocal fluorescence microscopy.

RATIONALE: Fibered confocal fluorescence microscopy (FCFM) is a new technique that produces microscopic imaging of a living tissue through a 1-mm fiberoptic probe that can be introduced into the working channel of the bronchoscope. OBJECTIVES: To analyze the microscopic autofluorescence structure of normal and pathologic bronchial mucosae using FCFM during bronchoscopy. METHODS: Bronchial FCFM and spectral analyses were performed at 488-nm excitation wavelength on two bronchial specimens ex vivo and in 29 individuals at high risk for lung cancer in vivo. Biopsies of in vivo FCFM-imaged areas were performed using autofluorescence bronchoscopy. RESULTS: Ex vivo and in vivo microscopic and spectral analyses showed that the FCFM signal mainly originates from the elastin component of the basement membrane zone. Five distinct reproducible microscopic patterns were recognized in the normal areas from the trachea down to the more distal respiratory bronchi. In areas of the proximal airways not previously biopsied, one of these patterns was found in 30 of 30 normal epithelia, whereas alterations of the autofluorescence microstructure were observed in 19 of 22 metaplastic or dysplastic samples, five of five carcinomas in situ, and two of two invasive lesions. Disorganization of the fibered network could be found on 9 of 27 preinvasive lesions, compatible with early disruptions of the basement membrane zone. FCFM alterations were also observed in a tracheobronchomegaly syndrome and in a sarcoidosis case. CONCLUSIONS: Endoscopic FCFM represents a minimally invasive method to study specific basement membrane alterations associated with premalignant bronchial lesions in vivo. The technique may also be useful to study the bronchial wall remodeling in nonmalignant chronic bronchial diseases.

Mucoepidermoid tumors of the bronchus. Ultrastructural and immunohistochemical study. Histiogenic correlations.

UNLABELLED: Bronchial mucoepidermoid tumors are uncommon neoplasms, morphologically similar to their salivary gland counterpart. The histogenesis is controversial. The aim of this study is to identify myoepithelial cells and speculate on their role in the origin of these tumors. METHODS AND RESULTS: Sixteen bronchial mucoepidermoid tumor surgical specimens were formalin-fixed, paraffin-embedded and studied using a panel of nine antibodies in order to identify a myoepithelial differentiation. Additional antigens against several cytokeratins were performed in four cases and five of the biopies were studied using the electron microscopy. The different types of cells of the primary bronchial mucoepidermoid tumor (mucous luminal, intermediate and squamous) reacted strongly against AE1, CK7, 34bE12 and weakly with AE3, CK18 and CK8/18/19. S-100, alpha-smooth muscle actin, muscle actin HHF35 and alpha-actinin were consistently negative in all cell types. CD10 was positive in very few cells in just one case. CONCLUSION: The immunohistochemical and the ultrastructural study of bronchial mucoepidermiod tumors support a ductal unit origin, without a myoepithelial participation.

Gangliocytic paraganglioma of the bronchus: a case report with follow-up and ultrastructural assessment.

We report a case of gangliocytic paraganglioma of bronchus. A 54-year-old woman underwent bronchoscopy following two episodes of right lower lobe pneumonia over the previous 5 months with unresolved chest radiographic changes. A computerized tomographic scan showed a right lower lobe endobronchial lesion, and at bronchoscopy there was a mass partly occluding the lumen of the bronchus. The biopsy and subsequent bronchoscopic resection showed a tumor with morphologic, immunohistochemical, and ultrastructural features of paragangliomatous, gangliocytic, and Schwann cell differentiation consistent with a gangliocytic paraganglioma. The lesion was treated conservatively with bronchoscopic resection and laser therapy. Histopathologic examination of recurrent tumor at 6 months showed features consistent with paraganglioma. Ten months after initial diagnosis, there was no bronchoscopic evidence of residual tumor. The occurrence of gangliocytic paraganglioma in diverse sites gives cause for the reappraisal of the histogenesis of this fascinating lesion. The variable morphology of this lesion may be an expression of the potential for divergent differentiation of a pluripotent stem cell.

Intranuclear inclusions in fine needle aspirates of bronchial low grade mucoepidermoid carcinoma with clear cell change: a report of two cases.

BACKGROUND: Mucoepidermoid carcinoma of the bronchus is a rare neoplasm that can be recognized on histology as well as cytology by the presence of three characteristic cell types: mucus secreting, epidermoid and intermediate. We encountered two cases displaying unusual cytologic features, including clear intranuclear inclusions. CASES: Two females, aged 33 and 39, presented with an intrabronchial tumor and pulmonary parenchymatous mass, respectively. Fine needle aspiration of both tumors showed similar cytologic features, with a dominant population of cells with bland nuclei and wide cytoplasm, and frequent intranuclear inclusions. A minor component of mucus-secreting cells was also recognized. Histologically, both tumors corresponded to the clear cell variant of mucoepidermoid carcinoma. CONCLUSION: The cytologic picture in our cases has not been described previously in fine needle aspirates of mucoepidermoid carcinoma, in neither the bronchus nor salivary gland. The differential diagnosis of a monotonous population of epithelial cells with intranuclear inclusions involves bronchioloalveolar carcinoma, but the absence of the characteristic sheet pattern, as well as the clinical and image findings, excludes this possibility. The lack of atypia and intrabronchial location limits the scope to carcinoid and salivary gland-type tumors of the bronchus. Since we were aware of the possibility of unusual cytologic presentations of mucoepidermoid carcinomas, search for different cellular populations suggested the precise diagnosis.

Bronchial carcinoid tumor with crystalloid cytoplasmic inclusions.

We report a bronchial carcinoid tumor with distinctive, cytoplasmic, rod-shaped crystalloid inclusions that were visible by light microscopy. These cytoplasmic structures were immunoreactive with antibodies against chromogranin A and synaptophysin in paraffin-embedded tissue. Ultrastructural studies showed them to be paracrystalline in nature and located within lysosomes. This case highlights an interesting, and potentially confusing, histologic manifestation in an otherwise typical bronchial carcinoid tumor.

Myoepithelial carcinoma of the lung arising from bronchial submucosa.

Myoepithelial neoplasm mainly occurs in the salivary glands and breasts and is extremely rare in the lung. To our knowledge, this report describes the first documented case of a myoepithelial carcinoma present in the lung. The tumor derived from the right main bronchial submucosa and exhibited a dual epithelial and smooth muscular phenotype by immunohistochemical and ultrastructural studies. It invaded the neighboring pulmonary tissue and the hilar lymph nodes. Despite a right pneumonectomy and chemotherapy, metastasis was found in the left lung 7 months later.

Amphicrine tumor.

The term amphicrine refers to cells, and tumors, which show both exocrine and endocrine features. Author s aim was to analyse the characteristics of these neoplasms. 40 suspicious cases were reviewed. Mucin-stains (PAS, diastase-PAS, Stains-all, Alcian-blue), immunohistochemistry (antibodies against Neuron-Specific Enolase (NSE), and Chromogranin A (CGA), and electronmicroscopic studies were performed to demonstrate exocrine and/or endocrine features of the tumor cells. By means of these methods, 16 cases turned out to be amphicrine tumors. Among them, there were 4 sinonasal, 1 bronchial, 1 mediastinal, 8 gastrointestinal and 2 suprarenal gland neoplasms. In connection to the subject, a brief review is given of amphicrine tumor, regarding its etiological and pathological aspects. These tumors form a distinct clinicopathological entity and should be separated from both neuroendocrine tumors and adenocarcinomas.

Value of rigid bronchoscopy and cytodiagnosis of bronchial washings in detecting bronchial carcinoma in the presence of a carcinoma of the upper aerodigestive tract.

OBJECTIVE: To assess the usefulness of rigid bronchoscopy and bronchial washings in detecting primary lung carcinomas. SETTING: Department of Otolaryngology, University Hospital of Ghent, Belgium. DESIGN: Prospective analysis of patient investigations. METHOD: The results of 127 rigid bronchoscopies with bronchial washings in patients with a new, untreated head and neck tumour and a normal chest radiograph were analyzed for their usefulness in detecting simultaneous primary lung carcinomas. All patients were followed for a minimum of 2 years or till death. RESULTS: We found positive bronchial washings in 19 cases (21%). Unilateral positive bronchial washings were found in 8 patients (9%). In only one patient was a simultaneous primary lung tumour found. One patient was found to have a pulmonary metastasis. The remaining 6 patients with positive unilateral cytology (6/8) had normal chest roentgenograms and/or CT scans, and did not develop a lung tumour in the course of follow up. Of the 19 positive bronchial washings, 10 patients had a carcinoma of the larynx and two had a large hypopharyngeal carcinoma. CONCLUSIONS: Contamination of bronchial washings with tumour cells from head and neck neoplasms limited seriously the usefulness of positive bronchial cytology. The sensitivity and specificity of the rigid bronchoscopy with bronchial washing is too low to justify its cost.

Cellular schwannoma of the bronchus.

A cellular schwannoma in a bronchus of a 64-year-old female is reported with immunocytochemical and ultrastructural observations. One previous case arising in the lung has been reported. The tumor formed a 3-cm exophytic mass in a segmental bronchus. Pneumonectomy was performed. The tumor was moderately cellular and devoid of Verocay bodies, and the spindle cells were immunoreactive for S-100 protein. Electron microscopy revealed schwannian features that were less developed than in a classic schwannoma.

Pleomorphic adenoma of the bronchus.

An example of pleomorphic adenoma of the bronchus is described in a 27 year old male student who was referred for evaluation of a coin lesion identified incidentally on chest x ray. The tumour exhibited the classic histological, immunohistochemical and ultrastructural features of this rare entity but, in addition, contained mature and immature adipose tissue in the stroma and showed transition, in its superficial portion, between ostensibly normal bronchial mucus glands and tumour tubules. Neither of these features has been commented upon previously.

Ultrastructural distinction of basaloid-squamous carcinoma and adenoid cystic carcinoma.

Basaloid-squamous carcinoma is a unique and infrequent variant of squamous cell carcinoma with a predilection for occurring in the upper aerodigestive tract. The cardinal diagnostic criteria are the presence of basaloid cells arranged in lobules or cords and a squamous component. Another feature that distinguishes basaloid-squamous carcinoma from conventional squamous cell carcinoma is the development of multiple foci of amorphous, eosinophilic, or mucinous materials among the basaloid tumor cells. It is this feature in basaloid-squamous carcinoma that causes confusion with adenoid cystic carcinoma, especially the solid variant of adenoid cystic carcinoma. To clarify the distinctive features of these two types of tumors, the ultrastructural findings in three basaloid-squamous carcinomas from the head and neck region were compared with three adenoid cystic carcinomas, one from the head and neck region and one each from trachea and bronchus. Widened intercellular spaces, tonofilaments, and replicated basal lamina were present in both types of tumor. However, the ultrastructural features of glandular differentiation were present only in adenoid cystic carcinoma, whereas the ultrastructural features of squamous cell differentiation were present only in basaloid-squamous carcinoma. The distinction between basaloid-squamous carcinoma and adenoid cystic carcinoma is important since basaloid-squamous carcinoma is a clinically aggressive, high-grade form of squamous cell carcinoma, generally with a worse prognosis than adenoid cystic carcinoma.

Truly benign "bronchial adenoma". Report of 10 cases of mucous gland adenoma with immunohistochemical and ultrastructural findings.

Mucous gland adenoma of the bronchus (MGAB) is a rare, solitary, benign, well-circumscribed, multicystic, predominately exophytic bronchial tumor. Mucous gland adenoma arises from the submucosal seromucous glands and ducts of proximal airways; since the location, signs and symptoms, and bronchoscopic findings are similar to those of other tumors arising in the bronchus, diagnosis depends on tissue biopsy. We herein report 10 patients with MGAB. Patients ranged in age from 25 to 67 years old (mean, 52). In two thirds of patients, the tumor was located in the middle or lower lobes. Tumors ranged in size from 0.8 to 6.8 cm (mean, 1.8). Cut surface was shiny, mucoid, cystic, and usually firm. Mucous gland adenomas are protean in their histologic patterns. They may appear glandular and tubulocystic or papillocystic, and they often show a mixture of these features. The tumors are rich in mucins and are immunopositive for epithelial markers. Mucous gland adenoma needs to be distinguished from low-grade malignant tumors of the bronchus--most notably, low-grade mucoepidermoid carcinoma. Complete removal of the tumor is curative.

AgNOR counts in preneoplastic lesions of the bronchus.

Silver staining of argyrophil nucleolar organizer regions (AgNORs) has become a valuable method to assess cell kinetics in paraffin sections and separate benign from malignant lesions. As a putative technique for the distinction between regenerative and preneoplastic alterations of the bronchial mucosa we employed the Ag-staining method, evaluating the number of dots/nucleus and shape of the dots. Dots/nucleus were counted by by standardized methods, and mean and standard deviation were calculated. Comparative investigations were performed in bioptically obtained specimens of normal bronchial epithelium (1.94 +/- 0.1 dots/nucleus, n = 12), basal cell hyperplasia (2.22 +/- 0.13 dots/nucleus, n = 15), goblet cell hyperplasia (2.38 +/- 0.16 dots/nucleus, n = 17), squamous cell metaplasia (2.58 +/- 0.17 dots/nucleus, n = 25), squamous cell metaplasia with mild and moderate dysplasia (2.50 +/- 0.5 dots/nucleus, n = 15), squamous cell metaplasia with severe dysplasia and carcinoma in situ (3.10 +/- 0.47 dots/nucleus, n = 17), micropapillomatosis (2.20 +/- 0.21 dots/nucleus, n = 13) and early squamous cell carcinoma of the bronchus (4.40 +/- 0.74, n = 13). In preneoplastic lesions a variability in form and size of the dots was found. Though showing an increase in the number of dots/nucleus coincidentally with the degree of proliferative activity, the AgNOR method cannot be considered as a statistically significant tool in the evaluation of regenerative and preneoplastic lesions in bioptically obtained specimens.

Computer-aided analysis of the nuclear area in proliferative lesions of the colonic and bronchial epithelium.

The aim of this study was to establish the diagnostical value of nuclear area in proliferative lesions of colonic and bronchial epithelium. The study included 11 adenomas and 9 adenocarcinomas of colon, 11 control samples of normal colonic epithelium as well as 5 cases of bronchial squamous cell metaplasia, 25 squamous cell carcinomas, 9 small cell carcinomas and 3 adenocarcinomas of bronchi and 13 control samples of normal bronchial epithelium. All tissue samples were formalin fixed, paraffin embedded and silver stained. Morphometrical analysis was performed using optical Axiophot microscope with immersion, B/W CCD camera connected to frame grabber card, computer PC AT 386 and morphometrical software Vist and Morpho. Nuclear area was measured semiautomatically. Within each case 100 nuclei were analyzed. Statistically significant differences between carcinoma and adenoma or normal epithelium were observed in colon. In bronchi nuclear area was significantly higher in squamous cell carcinoma and adenocarcinoma if compared with other lesions including small cell carcinoma or bronchial metaplasia and normal epithelium.

Ultrastructural heterogeneity in undifferentiated bronchial carcinoma.

Electron microscopy is often suggested as a useful aid to the classification of light microscopically undifferentiated bronchial malignancies, features such as dense-core vesicles, desmosomes or tonofilaments, and microacini, allowing their designation as endocrine, squamous, or adenocarcinomas respectively. However, there is no reason to suppose that the heterogeneity of malignant bronchial tumours so often apparent by light microscopy or on immunolabelling might not occur at the ultrastructural level too. Extensive sampling of all deposits from eight subjects coming to necropsy with undifferentiated bronchial carcinoma revealed ultrastructural features of glandular and squamous differentiation to be widespread and often to occur together, although dense-core vesicles were not seen in any of the tumours studied. Heterogeneity was present within individual tumour deposits and particularly between different deposits of those tumours which had disseminated, such that any ultrastructural diagnosis would have been significantly influenced by sampling. Such variation should be borne in mind when ultrastructural features are used to classify bronchial malignancies.

Primary pulmonary tumors in childhood: a review of 31 years' experience and the literature.

Primary pulmonary tumors are infrequent in childhood, therefore an accurate diagnosis and treatment is often delayed. We review the English language literature and report the clinical and pathological features of eight tumors arising in the lungs of pre-adolescent children, accessioned between 1960 and 1991 in the pathology department of a children's hospital in South Africa. The ratio of pulmonary primary tumors to secondary neoplasms and to non-neoplastic lesions of the lung examined during this period was 1:5:60. Over the last 31 years we received three plasma cell granulomas, two pleuro-pulmonary blastomas, a mucoepidermoid carcinoma, an endobronchial fibrosarcoma, and a hemangioma. All patients presented with cough unresponsive to medical treatment. The incidence and spread of primary lung tumors in children was similar to that reported from other centers. Plasma cell granuloma is the most common primary tumor in the lungs of children. Aggressive behavior is most frequently encountered with pleuro-pulmonary blastoma and rhabdomyosarcoma, and because of their association with cystic lesions careful examination of lungs is required in such cases. Most other malignant neoplasms, such as muco-epidermoid carcinoma and primary fibrosarcoma, are usually of a low grade of malignancy. A decreasing incidence of bronchogenic carcinoma seems to be reported during the first two decades of life.