134 Solitary Pulmonary Mixed Squamous and Glandular Papilloma: A Case Report and Review of Literature. (11th January 2018)

• Record Type: Journal Article
• Authors: Malik, Aatika; Aneja, Amandeep; Mukherjee, Abir
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S58
• Page End: S58
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx119.133
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Solitary pulmonary papilloma can be of squamous, glandular or mixed subtype. Mixed squamous and glandular papilloma of the lung is an extremely rare neoplasm, with only 20 cases reported in the literature. Herein we report an unusual case of peripherally located mixed papilloma in a 71-year-old nonsmoking woman. The patient presented with a three-month history of cough. Chest CT scan with contrast revealed a 4.4 x 2.4 x 2.2 cm heterogeneous spiculated left apical mass with possible pleural involvement. PET/CT scan demonstrated high metabolic activity (SUV 17) suggesting malignancy. Several sub-centimeter-sized mediastinal lymph nodes, some with calcifications were also noted. Metastatic work-up was negative. Fine needle aspiration of the mass showed reactive bronchial epithelial cells and a few inflammatory cells. Left upper lobectomy was performed.On gross inspection, a 4.2 x 3.6 cm solid white tan, ill-defined mass was identified with puckering of overlying pleura. Histology showed an expansile tumor, appearing to arise from an endobronchial location with focally infiltrative growth pattern. The tumor was composed of proliferating papillary tufts lined by squamous epithelium and glandular epithelium with overlying columnar ciliated cells. The adjacent lung showed prominent fibrosis due to tumor expansion and growth with interspersed squamous islands. The tumor cells, both the squamous and glandular components, had minimal cytological atypia with no mitosis or necrosis. The overlying pleura and margins were free of tumor. The tumor cells were positive for CK5/6 and p63 while negative for TTF-1, CK7 and Napsin A, CK20, and P16. Reported cases of pulmonary mixed papilloma have male to female ratio of 3:1, with median age of presentation at sixth decade. Vast majority of these cases are centrally located and endobronchial. Surgical resection is considered curative, with only one case of transformation to squamous cell carcinoma reported.