AJR 2004; 183:282
© American Roentgen Ray Society
Radiologic-Pathologic Conferences of Massachusetts General
Hospital |
Mucinous Cystadenoma of the Lung
Alexander R. Guimaraes1,
John C. Wain2,
Eugene J. Mark3 and
Conrad Wittram1
1 Department of Radiology, Division of Thoracic Radiology, Massachusetts General
Hospital and Harvard University, 55 Fruit St., Boston, MA 02114.
2 Department of Thoracic Surgery Radiology, Massachusetts General Hospital and
Harvard University, Boston, MA 02114.
3 Department of Pathology, Massachusetts General Hospital and Harvard
University, Boston, MA 02114.
Received August 5, 2003;
accepted after revision February 2, 2004.
Address correspondence to C. Wittram.
A75-year-old man presented with a 6.4-cm mass in the right lower lobe that
had measured 5.3 cm on a radiograph obtained 8 months earlier
(Fig. 1A). CT was performed;
the scans revealed a smooth margined mass with homogeneous density and a lack
of significant adjacent atelectasis (Fig.
1B). Three years earlier, the same lesion had measured 2 cm on a
chest radiograph obtained at an outside institution. At that time, fine-needle
aspiration biopsy was performed; it showed the mass as a myxoid matrix
containing single- and binucleate bland-appearing cells suggestive of benign
chondrocytes, which is suggestive of a hamartoma.
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Fig. 1A. —Mucinous cystadenoma of lung in 75-year-old man. Cropped
posteroanterior lateral radiograph of right lung base reveals lobulated mass
in posterior right lower lobe abutting pleural surface. No evidence of hilar
or mediastinal adenopathy or of pleural fluid collection is visible.
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Fig. 1B. —Mucinous cystadenoma of lung in 75-year-old man. Cropped CT
scan of right lower lobe at mid thorax obtained using soft-tissue window
settings shows that well-circumscribed lesion measuring 7.6 cm in diameter is
in periphery of right lower lobe, which is immediately adjacent to pleura.
Mass was homogeneous in density; it measured 25 H. Peripheral thin rim
enhancement is visible.
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In view of the relative enlargement of the mass, the patient underwent
operative evaluation. Bronchoscopy revealed evidence of distortion of the
anterior and lateral basilar segments of the right lower lobe, without
evidence of an endobronchial lesion. Thoracoscopic evaluation yielded no
evidence of an intrapleural lesion, with benign thickening of the pleura in
the right costovertebral sulcus. As a result of the complete intraparenchymal
aspect of this lesion, surgical resection was favored and the patient
underwent a complete right lower lobectomy. Gross pathologic evaluation
revealed a 7.5 x 6 x 6.0 cm diffusely hemorrhagic mass in the lung
parenchyma with a large area of necrotic and hemorrhagic pleural surface
overlying the mass. Histologic examination showed multiple foci of adenomatous
lining with mild atypia, which is consistent with a mucinous cystadenoma of
the lung (Fig. 1C). The patient
has no evidence of recurrence or recent hospitalizations.
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Fig. 1C. —Mucinous cystadenoma of lung in 75-year-old man.
Photomicrograph of specimen of mucinous cyst shows scant cells
(right) separated from normal lung (left) by fibrous wall
(middle). (H and E, x10)
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Mucinous cystadenoma of the lung is a rare benign tumor with few reported
cases
[1–3].
This tumor is generally unilocular and filled with mucus. The cysts are lined
by mucinous epithelium with varying degrees of atypia. Focal disruption of the
cyst wall may occur. Pathologically, the tumors must be distinguished from
bronchogenic cysts and from mucinous forms of bronchioalveolar cell carcinoma.
The former generally has some ciliated cells in the lining and has smooth
muscle, mucinous glands, or cartilage in its wall. The latter lacks a cyst
wall and has nuclear pleomorphism and lepidic spread of the malignant cells
[4]. Secondary to mucin
production, these lesions can exhibit interval growth, however benign in
etiology.
Typical radiologic features may be helpful in distinguishing mucinous
cystadenoma of the lung from other more malignant lesions. These lesions tend
to be well-demarcated singular cystic masses in the periphery of the lung
parenchyma
[1–3].
Although there seems to be a predilection for the right lung, the small sample
size precludes this distinction. These cystic lesions are typically, but not
necessarily, unilocular. As a result, they are homogeneous on CT, as our case
showed. In addition, the cyst wall is usually thin with mild inflammatory
changes in the adjacent lung parenchyma
[3]. The final diagnosis in
this case was mucinous cystadenoma of the lung, the radiologic findings of
which include unilocular macrocystic lesions in the periphery of the lung
parenchyma that can affect any lobe of the lung.
References
- Kragel PJ, Devaney KO, Meth BM, et al. Mucinous cystadenoma of the
lung: a report of two cases with immunohistochemical and ultrastructural
analysis. Arch Pathol Lab Med1990; 114:1053
-1056[Medline]
- Traub B. Mucinous cystadenoma of the lung. Arch Pathol
Lab Med 1991;115:740
-741[Medline]
- Roux FJ, Lantuejoul S, Brambilla E, et al. Mucinous cystadenoma of
the lung. Cancer1995; 76:1540
-1544[Medline]
- Graeme-Cook F, Mark EJ. Pulmonary mucinous cystic tumors of
borderline malignancy. Hum Pathol1991; 22:185
-190[Medline]
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