대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Mucoepidermoid carcinoma of the bronchus, low grade

Radiologic Findings

PA chest radiograph shows a mass-like density overlying the right hilum.
Mediastinal setting of the chest CT scan shows a well-defined, lobulated, enhancing lesion in the apical segment of the right lower lobe with a small right hilar node. The lesion shows no internal calcification or fat density.
Lung window reveals that the apical segmental bronchus cannot be separately visualized from the lesion and that the distal sub-segmental bronchi shows mild bronchiectasis. There is no air trapping / atelectasis or consolidation peripheral to the lesion.
CT guided biopsy proved the diagnosis of low grade mucoepidermoid carcinoma, and right lower lobectomy was subsequently performed. Pathology showed a lobulated solid mass arising from the apical segmental bronchus. Histopathology revealed an admixture of mucinous and intermediate type cells with tumor lobules pushing against the adjacent lung parenchyma, with no tumor associated atelectasis. The hilar node was also resected and was negative for tumor.

Brief Review

Mucoepidermoid carcinoma is a malignant glandular epithelial neoplasm. It is most commonly seen in the salivary glands, however, can be seen in the breast, pancreas, thyroid, trachea and bronchus, albeit rarely. Pulmonary mucoepidermoid carcinoma is a rare occurrence and represents only 0.1 to 0.5% of all lung carcinomas, however, is among the common childhood primary malignant tumors of the lung accounting for 10% of cases. Since pulmonary carcinoma is rare in children, primary diagnostic consideration is given to respiratory tract infections and is empirically treated; hence, carcinomas are detected late.
Mucoepidermoid carcinoma commonly presents with cough, hemoptysis, wheezing, chest pain, fever and sometimes clubbing of fingers. In a child with recurrent pneumonia or hemoptysis, mucoepidormoid carcinoma should be considered among the differential diagnoses and imaging with radiograph and CT should be performed to confirm the diagnosis.

References

1. Xiaozhe Qian, Zhiyong Sun, Wenbiao Pan, Qing Ye, Jun Tang, Ziang Cao. Childhood bronchial mucoepidermoid tumors: A case report and literature review. Oncol Lett. 2013 Nov; 6(5): 1409-1412. PMCID: PMC3813739. Published online 2013 Aug 16. Doi: 10.3892/ol.2013.1529

Keywords

Airway, Malignant tumor,