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Presented by Pedram Argani, M.D. and prepared by Doreen Nguyen, M.D.
Case 1: This is a 57 year-old male with a peripheral lung mass.
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Question 1 of 1
1. Question
Week 605: Case 1
This is a 57 year-old male with a peripheral lung mass.
Correct
Answer: Metastatic adenoid cystic carcinoma
Histology: This is a basaloid neoplasm which involves peripheral lung and abuts the pleura. Cells are fairly uniform, and in some areas appear to colonize the existing alveolated septa, simulating a bronchioloalveolar adenocarcinoma (lepidic growth pattern). However, one can focally appreciate a dual cell population, with myoepithelial cells surrounding hyalinized basement membrane material. The lesion lacks marked nuclear atypia. This patient was subsequently discovered to have had prior surgery for an adenoid cystic carcinoma of the palate. Therefore, the current lesion represents a metastasis.
Discussion: Adenocarcinoma of the lung would demonstrate greater atypia, and would not show the biphasic pattern seen in this case. Carcinoid tumors may be somewhat similar cytologically, but would label for neuroendocrine markers and again would not demonstrate a dimorphic cell population. Basaloid squamous carcinoma would demonstrate greater cytologic atypia, and show overt areas of squamous differentiation.
Adenoid cystic carcinomas may recur late, long after the prior surgery has been remembered by the clinical team. Adenoid cystic carcinoma typically harbors t(6;9)(q22:p23) translocation which fusions the MYB and NFIB transcription factor genes.
Incorrect
Answer: Metastatic adenoid cystic carcinoma
Histology: This is a basaloid neoplasm which involves peripheral lung and abuts the pleura. Cells are fairly uniform, and in some areas appear to colonize the existing alveolated septa, simulating a bronchioloalveolar adenocarcinoma (lepidic growth pattern). However, one can focally appreciate a dual cell population, with myoepithelial cells surrounding hyalinized basement membrane material. The lesion lacks marked nuclear atypia. This patient was subsequently discovered to have had prior surgery for an adenoid cystic carcinoma of the palate. Therefore, the current lesion represents a metastasis.
Discussion: Adenocarcinoma of the lung would demonstrate greater atypia, and would not show the biphasic pattern seen in this case. Carcinoid tumors may be somewhat similar cytologically, but would label for neuroendocrine markers and again would not demonstrate a dimorphic cell population. Basaloid squamous carcinoma would demonstrate greater cytologic atypia, and show overt areas of squamous differentiation.
Adenoid cystic carcinomas may recur late, long after the prior surgery has been remembered by the clinical team. Adenoid cystic carcinoma typically harbors t(6;9)(q22:p23) translocation which fusions the MYB and NFIB transcription factor genes.
