Case 4 Junya Fukuoka, MD. PhD. Nagasaki University Graduate School - - PowerPoint PPT Presentation

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Oct 07, 2022 487 likes •817 views

Case 4 Junya Fukuoka, MD. PhD. Nagasaki University Graduate School of Biomedical Sciences Kameda Medical Center Case 4: Pulmonary nodule 50 year old woman detected to have abnormal shadow in her regular health screening. Never smoking

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Case 4

Junya Fukuoka, MD. PhD. Nagasaki University Graduate School of Biomedical Sciences Kameda Medical Center

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Case 4: Pulmonary nodule

50 year old woman detected to have abnormal

shadow in her regular health screening.

Never smoking history.
No familial history of lung disease.
Left upper lobe mass.
Lobectomy was performed.

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Pathological features by H&E

Single nodule with abundant mucin production
Focal papillary structure
Focal inflammatory changes
Focal ciliated epithelia
Minimal cellular atypia
No mitosis
Multi‐focal basal cell hyperplasia

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Differential diagnosis (H&E):

Early invasive mucinous adenocarcinoma (IMA)
Inflammatory scar with abundant bronchiolar

metaplasia

Glandular papilloma
Mixed squamous and glandular papilloma
Ciliated muconodular papillary tumor (CMPT)
Metastatic carcinoma from GI tract (esp panc)

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HNF4α TTF‐1 p40 CK7

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BRAF (V600E)

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Differential diagnosis:

Early invasive mucinous adenocarcinoma (IMA)
Inflammatory scar with abundant bronchiolar

metaplasia

Glandular papilloma
Mixed squamous and glandular papilloma
Ciliated muconodular papillary tumor (CMPT)

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Ciliated muconodular papillary tumor (CMPT)

Recently proposed disease.
First report is 2002 (Japanese) by Ishikawa

et al.

Nearly 40 cases reported, mostly from Asia.
Harboring frequent mutation
No recurrent occur but does not have long

term follow up data

Little association with bronchial wall
Female≒male
Little association with smoking
Solitary nodule (1‐2cm) >> multiple

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Molecular data of CMPT

BRAF V600E
KRAS G12D, G12V, G12C
EGFR ex19/20 uncommon mut
HRAS , ALK mutation (very few)

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IHC of CMPT

TTF1 mostly+
CK7+ / CK20‐ (may be focal+)
HNF4α (vary ++, +, ‐)
p40, p63+ basal cells (continuous or discontinuous)
p53 mostly wild type pattern.

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Then, how about this case?

71 year old woman
Detected to have abnormal

shadow.

No symptom
Never smoker

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HNF4α

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p63

Invasive mucinous adenocarcinoma

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How to make judge for small biopsy?
How about frozen?

But the issue is…

NEED IMMUNO?? Do lobectomy + LN dissection?

r wedge only?

Mutation may not separate them!

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CMPT. Some are early IMA?

Miyai K et al. Pathol Int 2018

Well, may not be….

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However!!! Recent Publication from MSKCC

The new concept of “Bronchial Adenoma” for all

similar conditions.

There are several cases not completely fit to the

criteria of CMPT. (lack mucous, cilia, papillary structure…)

But share most of molecular abnormality and

clinical pictures.

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Chang et al, AJSP 2018

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