Ewha Med J.  2015 Jul;38(2):85-89. 10.12771/emj.2015.38.2.85.

Metastatic Pulmonary Mucoepidermoid Carcinoma with Fulminant Clinical Course

• Park YW
• Yoon SB
• Cheon MJ
• Koh YM
• Oh HS
• Kim SJ
• Lee SH

• KMID: 2052787
• DOI: http://doi.org/10.12771/emj.2015.38.2.85

Abstract

Pulmonary mucoepidermoid carcinoma (MEC) is a rare form of lung cancer that originates from submucosal glands of tracheobronchial tree. Unlike low-grade tumor with benign nature, high-grade case is even rarer and has aggressive clinical features with no definite treatment option. Here, we report a case of high-grade pulmonary MEC with fulminant clinical course. A 74-year-old man presented with cough, sputum and mental change. Chest imaging showed massive mediastinal lymphadenopathy with obstructive pneumonia, and multiple metastases in lung and adrenal gland. Bronchoscopy showed polypoid masses obstructing right main bronchus and bronchus intermedius. Histopathology revealed a mixture of glandular structure lined with mucussecreting cells and nests of squamoid cells with nuclear atypia and pleomorphism, which is compatible with high-grade MEC. We intensively treated the patient with combination antibiotics and ventilator care. However, the patient did not respond to the treatment and rapidly deteriorated, and finally expired a month after diagnosis.

Keyword

Mucoepidermoid carcinoma; Metastasis; Lung neoplasm

MeSH Terms

Adrenal Glands
Aged
Anti-Bacterial Agents
Bronchi
Bronchoscopy
Carcinoma, Mucoepidermoid*
Cough
Diagnosis
Humans
Lung
Lung Neoplasms
Lymphatic Diseases
Neoplasm Metastasis
Pneumonia
Sputum
Thorax
Ventilators, Mechanical
Anti-Bacterial Agents

Figure

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  Fig. 1 Chest radiography at presentation. It shows increased opacity at right lower lung field and hyperlucent left lung, suggestive of collapsed right lower lobe.

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  Fig. 2 Chest computed tomography scan. It reveals hugely enlarged upper paratracheal lymph node compressing trachea (A), and subcarinal lymph node and an endobronchial mass arrow associated with atelectasis of right lower lobe and pleural effusion (B). About 2 cm-sized right adrenal mass (C) and a metastatic nodule in left lower lung were also noted (D).

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  Fig. 3 Bronchoscopic findings. It shows two endobronchial masses arising at right main bronchus and the orifice of right bronchus intermedius. The masses are 1-2 cm-sized, well-circumscribed hypervascular polypoid tumors.

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  Fig. 4 Histopathologic images. Hematoxylin and eosin staining shows glandular structures with mucus-secreting cells (A), nests of squamoid and intermediated cells (B). Immnuohistochemistry shows positive staining in cytokeratin 7 (C) and negative staining in thyroid transcription factor-1 (D). The nuclei are pleomorphic and show frequent mitosis (arrows), compatible with high-grade mucoepidermoid carcinoma (×200).

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