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Pulmonary Pathology Online

Pathology of Mucoepidermoid Carcinoma of the Lung

 Dr Sampurna Roy MD

 

                                                                                                                      

 

 

Mucoepidermoid carcinoma (MEC) is the most common primary salivary gland-type tumour of the lung.

It arises from the excretory ducts of the bronchial mucosa.

This rare tumor is more common in adults than in children, and infrequently presents with hemoptysis. 

In children and adolescents, primary neoplasms of the tracheobronchial tree and lungs are rare, with most tumors involving the respiratory system being metastatic, small, blue cell tumours of childhood.

Of the primary pulmonary neoplasms, most are malignant with mucoepidermoid carcinoma representing about 10% of these malignant tumors.

Mucoepidermoid tumours of the tracheobronchial tree carry a more favorable prognosis in children than adults.

The tumour can be successfully managed by surgical intervention alone in children and adolescents.

Recurrent pneumonia and persistent cough are the most common presenting findings in children.

These tumours are of low-grade malignant potential but they can become locally invasive, extending into cartilage and surrounding soft tissue. 

Mucoepidermoid carcinoma of the tracheobronchial tree, usually located in a segmental bronchus, appears at CT as a smoothly oval or lobulated airway mass.

It adapts to the branching features of the airways.

The tumour usually presents as a polypoid endobronchial mass involving the proximal bronchi. High-grade mucoepidermoid carcinoma of the lung may present as a cavitary lesion.

It is classified into low- and high-grade tumours using criteria derived from similar tumours of the major salivary glands.

Low-grade MEC behaves in a benign fashion with less parenchymal and hilar lymph nodal invasion.

Note : Mucoepidermoid carcinoma of the bronchus can be recognized on histology as well as cytology by the presence of three characteristic cell types: mucus secreting, epidermoid and intermediate.

Histologically, the tumour displays an elaborate tubulocystic epithelial component. It is composed of intermediate, sheets of cells with epidermoid differentiation, and mucus-producing cells containing intra and extracellular mucin, and variable numbers of clear cells, multinucleated giant cells, columnar cells, and oncocytic cells.

Low grade tumour : Marked cellular atypia is absent in the solid or epidermoid component.

High grade tumour: There is marked cellular atypia , prominent mitotic activity, areas of necrosis and hemorrhage. (Differential diagnosis : Poorly differentiated squamous cell carcinoma). PAS and mucicarmine may be useful in identifying scattered mucocytes in poorly differentiated tumours.

In some cases dense lymphoplasmacytic infiltrate with occasional Russell bodies may be present. (Differential diagnosis :  low-grade lymphoma )

Further reading:

Prognosis of mucoepidermoid carcinoma of the bronchi

Pulmonary mucoepidermoid carcinoma with prominent tumor-associated lymphoid proliferation.

Mucoepidermal carcinoma of the lung detected by positron emission tomography in a 5-year-old girl.

Mucoepidermoid carcinoma as an unusual cause for recurrent respiratory infections in a child. 

Bronchoscopic Nd-YAG laser surgery for tracheobronchial mucoepidermoid carcinoma--a report of two cases.

Mucoepidermoid carcinoma of the lung presenting as a cavitary lesion.

Mucoepidermoid carcinoma of the bronchus presenting with a negative chest X-ray and normal pulmonary function in two teenagers: two case reports and review of the literature.

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

Three cases of pulmonary mucoepidermoid carcinoma.

Cytology of primary pulmonary mucoepidermoid and adenoid cystic carcinoma. A report of four cases.

Mucoepidermoid tracheo-bronchial tumors in adulthood. A series of 22 cases].

Childhood bronchial mucoepidermoid tumors: A case report and literature review.

Mucoepidermoid carcinoma of the tracheobronchial tree: radiographic and CT findings in 12 patients.

Tracheobronchial mucoepidermoid carcinoma in childhood and adolescence: case report and review of the literature.

A child with a t(11;19)(q14-21;p12) in a pulmonary mucoepidermoid carcinoma.

An experience with surgical treatment for mucoepidermoid carcinoma of the lungs .

Peripheral low-grade mucoepidermoid carcinoma of the lung--needle aspiration cytodiagnosis and histology.

 

                                                                                  

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 


 

 

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