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Weekly Chest CasesArchive of Old Cases

Case No : 1133 Date 2019-07-16

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  • Courtesy of Chul Hwan Park, Jae Min Shin, Tae Hoon Kim / Gangnam Severance Hospital, Yonsei University College of Medicine
  • Age/Sex 32 / M
  • Chief ComplaintHemoptysis, 1 day
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Mucoepidermoid carcinoma
Radiologic Findings
Figs 1-3. Chest CT images show an irregularly shaped lobulated nodule, approximately 2.8 cm in size, in the right middle lobe with heterogeneous enhancement and right middle lobe bronchus obliteration.
Fig 4. F-18 FDG PET/CT image shows mild FDG uptake at the central portion of the nodule in the right middle lobe.

Bronchoscopy showed total luminal obstruction at the proximal aspect of right middle lobe bronchus (A). Bronchoscopic biopsy was performed, and a histopathologic diagnosis of non-small cell lung cancer, favoring salivary gland-type carcinoma, was made. Lobectomy of the right middle lobe was performed (B). Histopathologic diagnosis included a high-grade mucoepidermoid carcinoma (MEC), composed mainly of intermediate cells, squamous cells, and mucin-secreting cells.

(A)

(B)

Brief Review
Pulmonary mucoepidermoid carcinoma (PMEC) is a primary salivary gland-type lung cancer. PMEC is rare and accounts for 0.1% of all pulmonary malignancies (1). PMEC is classified into low-grade PMEC and high-grade PMEC (2). Low-grade PMEC consists of a glandular element and mucus-secreting cells, and high-grade PMEC consists of sheets or nests of squamous and intermediate cells (2). CT features of PMEC include a well-defined or lobulated intraluminal mass with heterogeneous contrast enhancement. Low-grade PMEC tends to present as a well-defined homogeneous nodule; in contrast, high-grade PMEC presents as ill-defined or lobulated nodules with heterogeneous enhancement (3-5). On FDG PET/CT, low-grade PMEC is usually non-FDG avid; in contrast high-grade PMEC may be FDG-avid. Finally, Low-grade PMEC has a favorable prognosis compared to other lung cancers, whereas the prognosis of high-grade PMEC is similar to that of other non-small cell lung cancers (3).
Please refer to
Case 34, Case 100, Case 33, Case 483, Case 498, Case 645, Case 816, Case 928,
KSTR Imaging Conference 2003 Summer  Case 7 ,
KSTR Imaging Conference 2004 Summer  Case 3 ,
KSTR imaging conference 2017 Summer  Case 9,
References
Kumar V, Soni P, Garg M, et al. A Comparative Study of Primary Adenoid Cystic and Mucoepidermoid Carcinoma of Lung. Front Oncol 2018;8:153. doi:10.3389/fonc.2018.00153.
2. Alsidawi S, Morris JC, Wikenheiser-Brokamp KA, Starnes SL, Karim NA. Mucoepidermoid carcinoma of the lung: a case report and literature review. Case Rep Oncol Med 2013;2013:625243. doi:10.1155/2013/625243.
3. Cheng DL, Hu YX, Hu PQ, Wen G, Liu K. Clinicopathological and multisection CT features of primary pulmonary mucoepidermoid carcinoma. Clin Radiol 2017;72:610.e611-610.e617. doi:10.1016/j.crad.2017.02.007.
4. Xi JJ, Jiang W, Lu SH, Zhang CY, Fan H, Wang Q. Primary pulmonary mucoepidermoid carcinoma: an analysis of 21 cases. World J Surg Oncol 2012;10:232. doi:10.1186/1477-7819-10-232.
5. Li X, Yi W, Zeng Q. CT features and differential diagnosis of primary pulmonary mucoepidermoid carcinoma and pulmonary adenoid cystic carcinoma. J Thorac Dis 2018;10:6501-6508. doi:10.21037/jtd.2018.11.71.
Keywords
Airway, Malignant neoplasm,

No. of Applicants : 68

▶ Correct Answer : 8/68,  11.8%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Dae Jin Medical Center , Korea (South) JIYOUNG CHOI
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Correct Answer as Differential Diagnosis : 16/68,  23.5%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - , Korea (South) CHOHEE KIM
  • - Other , Korea (South) SEONGSU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - , Japan YUMI MAEHARA
  • - Jiangsu province hospital , China WANGJIAN ZHA
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