J Pathol Transl Med.  2020 Jan;54(1):119-122. 10.4132/jptm.2019.09.30.

Morule-like features in pulmonary adenocarcinoma associated with epidermal growth factor receptor mutations: two case reports with targeted next-generation sequencing analysis

Affiliations
  • 1Department of Pathology, Korea University Anam Hospital, Seoul, Korea

Abstract

Morules, or morule-like features, can be identified in benign and malignant lesions in various organs. Morular features are unusual in pulmonary adenocarcinoma cases with only 26 cases reported to date. Here, we describe two cases of pulmonary adenocarcinoma with morule-like features in Korean women. One patient had a non-mucinous-type adenocarcinoma in situ and the other had an acinarpredominant adenocarcinoma with a micropapillary component. Both patients showed multiple intra-alveolar, nodular, whorled proliferative foci composed of atypical spindle cells with eosinophilic cytoplasm. Targeted next-generation sequencing was performed on DNA extracted from formalin-fixed paraffin-embedded samples of the tumors. Results showed unusual epidermal growth factor receptor (EGFR) mutations, which are associated with drug resistance to EGFR tyrosine kinase inhibitors, revealing the importance of identifying morule-like features in pulmonary adenocarcinoma and the need for additional study, since there are few reported cases.

Keyword

Morule-like features; Pulmonary adenocarcinoma; Next-generation sequencing; Epidermal growth factor receptor

Figure

  • Fig. 1. Microscopic findings of the tumor. (A) The case of adenocarcinoma in situ shows lepidic growth of atypical columnar cells without definite evidence of stromal invasion. (B) Multiple nodular proliferative lesions in intra-alveolar spaces. The cells in those structures are atypical spindle cells that are positive for thyroid transcription factor 1 immunostaining (inset). (C) The acinar-predominant adenocarcinoma case shows multiple foci of morule-like components (D) floating within the intra-alveolar space.


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