대한흉부영상의학회 Weekly Chest Cases

Case No : 1146 Date 2019-10-17

Courtesy of Kwon Hye Young, Sung Shine Shim / Ewha Seoul Hospital, Ewha Womans University
Age/Sex 44 / F
Chief ComplaintIncidental radiologic abnormality

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Diagnosis With Brief Discussion

Diagnosis: Mucoepidermoid carcinoma
Radiologic Findings: Fig 1. Chest PA shows mass like consolidation in right middle lung zone
Fig 2-5. On CT images, There is about 2cm sized enhancing nodular lesion in RLL and this lesion make occlusion at RML lateral bronchus subsegmental branch
Fig 6. That nodule show mild hypermetabolism on PET CT
Brief Review: Pulmonary mucoepidermoid carcinoma (PMEC) is an uncommon neoplasm of the lung and the most common salivary gland malignancy. PMEC is usually located in the lobar or segmental bronchi, usually accompanied by distal bronchial dilatation with mucoid impaction. Although it is most commonly identified in the head and neck, it can occur in many sites of the body, including the breasts, lungs, skin, and thymus.
Clinically, PMEC occurs over a broad age range of 3–78 years with a peak age of diagnosis in the third and fourth decades. Although some studies have reported a male predominance, most reports fail to demonstrate a clear predilection regarding PMEC occurrence based on gender.
Symptoms primarily include bronchial irritation and obstruction, including cough, wheezing, hemoptysis, and postobstructive pneumonia.
Patchy areas of low density are usually observed in PMEC cases and the solid part of PMEC usually shows moderate or severe enhancement. Furthermore, on CT images, the central type of PMEC was characterized by limited nodules, and tumors' appearances included a circumferential or elevated soft tissue nodule with either a smooth, lobulated, or polypoid margin. Meanwhile, the hilar type usually manifested with nodules inside the lobar or segmental lumen, often accompanied by distal bronchial dilatation with mucoid impaction. Finally, the peripheral type was the least found type both in PMEC, and its lesions were all masses, originating from small bronchi.
PMEC is a low-grade malignancy, and therefore is mainly treated by surgical resection. The utility of chemotherapy and radiotherapy in these cases remains controversial. When complete resection is not possible, adjuvant therapy should be administered.
Please refer to: KSTR imaging conference 2017 Summer Case 9 ,
KSTR Imaging Conference 2004 Summer Case 3 ,
KSTR Imaging Conference 2003 Summer Case 7,
References: 1. Zhen H, Huanwen W, Ji L, Shanqing L, Shafei W, Yuanyuan L, Yufeng L, Jinling C, Xuan Z, Zhiyong L, Primary Pulmonary Mucoepidermoid Carcinoma: Histo-pathological and Moleculargenetic Studies of 26 Cases, PLoS One. 2015; 10(11): e0143169.
2. Xian Li1, Wei Yi2, Qingsi Zeng, CT features and differential diagnosis of primary pulmonary mucoepidermoid carcinoma and pulmonary adenoid cystic carcinoma, J Thorac Dis. 2018 Dec; 10(12): 6501–6508
Keywords: Airway, Malignant neoplasm, Mucoepidermoid carcinoma,

No. of Applicants : 56

▶ Correct Answer : 6/56, 10.7%

- Mayo Clinic , United States AKITOSHI INOUE
- , Korea (South) GABIN YUN
- National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
- Gifu University Hospital , Japan Yo Kaneko
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Asan Medical Center , Korea (South) JIHOON KIM

▶ Correct Answer as Differential Diagnosis : 15/56, 26.8%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- , Korea (South) HYEYOUNG CHOI
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Other , Korea (South) SEONGSU KANG
- , Japan NAOMI YUASA
- Ajou University Hospital , Korea (South) HYERIN KIM
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- University of Tsukuba Hospital , Japan SODAI HOSHIAI
- Toranomon Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- , Japan KAZUMA TERAUCHI
- Hamamatsu University Hospital , Japan YUKI HAYASHI
- Chonnam National University Hospital , Korea (South) JONG EUN LEE
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

▶ Semi-Correct Answer : 2/56, 3.6%

- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- , Korea (South) JANG SEONG WON

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1146 Date 2019-10-17

Discussion

No. of Applicants : 56