Journal of Pathology and Translational Medicine

Original Article

Size of Non-lepidic Invasive Pattern Predicts Recurrence in Pulmonary Mucinous Adenocarcinoma: Morphologic Analysis of 188 Resected Cases with Reappraisal of Invasion Criteria: Soohyun Hwang, Joungho Han, Misun Choi, Myung-Ju Ahn, Yong Soo Choi; J Pathol Transl Med. 2017;51(1):56-68. Published online October 16, 2016; DOI: https://doi.org/10.4132/jptm.2016.09.17

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Background
We reviewed a series of 188 resected pulmonary mucinous adenocarcinomas (MAs) to clarify the prognostic significance of lepidic and non-lepidic patterns.
Methods
Non-lepidic patterns were divided into bland, non-distorted acini with uncertain invasiveness (pattern 1), unequivocal invasion into stroma (pattern 2), or invasion into alveolar spaces (pattern 3).
Results
The mean proportion of invasive patterns (patterns 2 and 3) was lowest in small (≤ 3 cm) tumors, and gradually increased in intermediate (> 3 cm and ≤ 7 cm) and large (> 7 cm) tumors (8.4%, 34.3%, and 50.1%, respectively). Adjusted T (aT) stage, as determined by the size of invasive patterns, was positively correlated with adverse histologic and clinical features including older age, male sex, and ever smokers. aTis tumors, which were exclusively composed of lepidic pattern (n = 9), or a mixture of lepidic and pattern 1 (n = 40) without any invasive patterns, showed 100% disease- free survival (DFS). The aT1mi tumors, with minimal (≤ 5 mm) invasive patterns (n = 63), showed a 95.2% 5-year DFS, with recurrences (n = 2) limited to tumors greater than 3 cm in total size (n = 23). Both T and aT stage were significantly associated with DFS; however, survival within the separate T-stage subgroups was stratified according to the aT stage, most notably in the intermediatestage subgroups. In multivariate analysis, the size of invasive patterns (p = .020), pleural invasion (p < .001), and vascular invasion (p = .048) were independent predictors of recurrence, whereas total size failed to achieve statistical significance (p = .121).
Conclusions
This study provides a rationale for histologic risk stratification in pulmonary MA based on the extent of invasive growth patterns with refined criteria for invasion.

Citations

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Distinct Recurrence Pattern and Survival Outcomes of Invasive Mucinous Adenocarcinoma of the Lung: The Potential Role of Local Therapy in Intrapulmonary Spread
Dong Woog Yoon, Soohyun Hwang, Tae Hee Hong, Yoon-La Choi, Hong Kwan Kim, Yong Soo Choi, Jhingook Kim, Young Mog Shim, Jong Ho Cho
Annals of Surgical Oncology.2024; 31(1): 201. CrossRef
Pulmonary invasive mucinous adenocarcinoma
Wei‐Chin Chang, Yu Zhi Zhang, Andrew G Nicholson
Histopathology.2024; 84(1): 18. CrossRef
Micropapillary Pattern in Invasive Mucinous Adenocarcinoma of the Lung: Comparison With Invasive Non-Mucinous Adenocarcinoma
Hui He, Lue Li, Yuan-yuan Wen, Li-yong Qian, Zhi-qiang Yang
International Journal of Surgical Pathology.2023;[Epub] CrossRef
Radiological and clinical features of screening-detected pulmonary invasive mucinous adenocarcinoma
Dae Hyeon Kim, So Young Bae, Kwon Joong Na, Samina Park, In Kyu Park, Chang Hyun Kang, Young Tae Kim
Interactive CardioVascular and Thoracic Surgery.2022; 34(2): 229. CrossRef
Micropapillary Pattern in Invasive Mucinous Adenocarcinoma of the Lung: Comparison with Invasive Non-Mucinous Adenocarcinoma
Hui He, Yuanyuan Wen, Liyong Qian, Zhiqiang Yang
SSRN Electronic Journal .2022;[Epub] CrossRef
Optimal method for measuring invasive size that predicts survival in invasive mucinous adenocarcinoma of the lung
Tomonari Oki, Keiju Aokage, Shogo Nomura, Kenta Tane, Tomohiro Miyoshi, Norihiko Shiiya, Kazuhito Funai, Masahiro Tsuboi, Genichiro Ishii
Journal of Cancer Research and Clinical Oncology.2020; 146(5): 1291. CrossRef
Prognostic Impact of Histopathologic Features in Pulmonary Invasive Mucinous Adenocarcinomas
Wei-Chin Chang, Yu Zhi Zhang, Eric Lim, Andrew G Nicholson
American Journal of Clinical Pathology.2020; 154(1): 88. CrossRef

Brief Case Reports

A Rare Case of Pulmonary Papillary Adenoma in Old Aged Woman: A Brief Case Report: In Ho Choi, Joungho Han, Jung Won Moon, Yong Soo Choi, Kyung-Jong Lee; Korean J Pathol. 2014;48(1):66-68. Published online February 25, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.1.66

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Pulmonary papillary adenoma with malignant potential: a case report and literature review
Ping Liu, Junjian Feng, Min Yang, Jingqiu Chen, Luyao Fu, Junxu Lu
Diagnostic Pathology.2022;[Epub] CrossRef
Central papillary adenoma of the lung diagnosed in a bronchoscopy-guided FNA: Cytological and histological characterization of this rare entity
Iñigo Gorostiaga, Adriano Martinez-Aracil, Blanca Catón, Alvaro Perez-Rodriguez
Revista Española de Patología.2021; 54(3): 206. CrossRef
Retrospective study of clinical and pathologic features of pulmonary papillary adenoma
Pengcheng Zhou, Wei Yu, Li Wang, Qianming Xia, Keling Chen
Medicine.2020; 99(44): e23066. CrossRef
Pulmonary papillary adenoma presenting in central portion: a case report
Xu-Yong Lin, Qiang Han, En-Hua Wang, Yong Zhang
Diagnostic Pathology.2015;[Epub] CrossRef

Micropapillary Mucinous Adenocarcinoma of the Lung: A Brief Case Report: In Ho Choi, Boin Lee, Joungho Han, Chin A Yi, Yong Soo Choi, Jin Seok Ahn; Korean J Pathol. 2013;47(6):603-605. Published online December 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.6.603

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Molecular Pathology of Lung Cancer
James J. Saller, Theresa A. Boyle
Cold Spring Harbor Perspectives in Medicine.2022; 12(3): a037812. CrossRef
The clinicopathological significance of ALK rearrangements and KRAS and EGFR mutations in primary pulmonary mucinous adenocarcinoma
Yang Qu, Nanying Che, Dan Zhao, Chen Zhang, Dan Su, Lijuan Zhou, Lili Zhang, Chongli Wang, Haiqing Zhang, Lixin Wei
Tumor Biology.2015; 36(8): 6417. CrossRef
Cytomorphological identification of advanced pulmonary adenocarcinoma harboring KRAS mutation in lymph node fine‐needle aspiration specimens: Comparative investigation of adenocarcinoma with KRAS and EGFR mutations
Dae Hyun Song, Boram Lee, Yooju Shin, In Ho Choi, Sang Yun Ha, Jae Jun Lee, Min Eui Hong, Yoon‐La Choi, Joungho Han, Sang‐Won Um
Diagnostic Cytopathology.2015; 43(7): 539. CrossRef

Case Reports

Diffuse Pulmonary Meningotheliomatosis: A Case Report.: Jungsuk An, Heejung Park, Joungho Han, Tae Sung Kim, Yong Soo Choi, Moon Seok Choi, Sang Won Um; Korean J Pathol. 2011;45:S32-S35.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S32

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Abstract PDF

Diffuse pulmonary meningotheliomatosis (DPM) is an extremely rare condition. We herein report a unique case of DPM in a 54-year-old woman with a previous history of hepatocellular carcinoma. A chest computed tomography showed diffuse bilateral nodular infiltration, suggesting miliary spread of metastatic hepatocellular carcinoma. The patient underwent a video-assisted thoracoscopic surgery for diagnostic purposes. The cut surface of the lung specimen showed multiple dispersed small nodules, consisting of variably sized nests or whorls of bland epithelioid cells often along the walls of alveolar septa or in a perivascular network within the alveolar interstitium. The tumor cells showed immunoreactivity for epithelial membrane antigen, vimentin, and progesterone receptor. DPM should be included in the differential diagnosis of diffuse multiple small nodules or a reticular pattern in the radiologic studies.

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Minute Pulmonary Meningothelial-Like Nodules Simulating Hematogenous Lung Metastasis: A Case Report
Sang Kook Lee, Gi Jeong Kim, Young Jae Kim, Ah Young Leem, Eu Dong Hwang, Se Kyu Kim, Joon Chang, Young Ae Kang, Song Yee Kim
Tuberculosis and Respiratory Diseases.2013; 75(2): 67. CrossRef

Thymofibrolipoma: A Brief Case Report.: Gu Hyun Kang, Joungho Han, Tae Sung Kim, Yong Soo Choi, Sang Won Um; Korean J Pathol. 2010;44(3):338-340.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.3.338

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Abstract PDF

Thymofibrolipoma is an extremely rare tumor in the anterior mediastinum, and represents a histologic variant of the usual thymolipoma. Herein, we report a case of thymofibrolipoma in a 9-year-old girl who had a huge mass with fatty attenuation in the right hemithorax on chest computed tomography. She denied any subjective symptoms except mild fever. The surgically resected tumor was ovoid, soft and well-encapsulated, measuring 9.0 x 7.5 x 7.0 cm. The cut surface was light tan in color with yellowish streaks. Microscopically, two distinct areas were admixed in different proportions. One consisted of normal thymic tissue with subinvoluted features and the other was composed of extensive areas of collagenous tissue interspersed in mature adipose tissue. In a high power view, there were thin strands of remnant thymic epithelial cells, separating the pseudolobules. Thymofibrolipoma should be distinguished from other benign or malignant conditions, occurring in the anterior mediastinum, so that unnecessary treatment can be avoided.

Citations

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Unusual thymoma subtypes
Michael A. den Bakker
Diagnostic Histopathology.2023; 29(2): 105. CrossRef
Thymofibrolipoma: a case report and review of the literature
Ryu Jokoji, Emiko Tomita
Diagnostic Pathology.2022;[Epub] CrossRef
Thymoangiolipoma: A rare histologic variant of thymolipoma in a patient with myasthenia gravis
Mohammad Hossein Anbardar, Fatemeh Amirmoezi, Armin Amirian
Rare Tumors.2020; 12: 203636132097921. CrossRef

Original Article

Pathologic Findings of Surgically Resected Nontuberculous Mycobacterial Pulmonary Infection.: Hye Jong Song, Jung Suk An, Joungho Han, Won Jung Koh, Hong Kwang Kim, Yong Soo Choi; Korean J Pathol. 2010;44(1):56-62.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.56

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Abstract PDF: BACKGROUND
Surgical resection of the involved lung for nontuberculous mycobacteria (NTM) has become an important curative therapy. However, there is limited information on the histopathological features of NTM pulmonary disease in Korean patients with NTM infection.
METHODS
We evaluated 51 specimens from 49 patients who were treated at our referral center from 2002 to 2009.
RESULTS
Almost all the cases showed bronchiectasis with lymphocytic infiltration. Variable features of granulomatous inflammation were found; well-defined granulomas in the parenchyma (68.6%), pneumonia-like granulomatous lesions (49.0%) and granulomatous inflammation in the bronchial wall (41.2%) were identified. The microscopic findings of cavitary lesions (37.3%) showed that these lesions were composed of granulomas and necrosis.
CONCLUSIONS
The differentiation of tuberculosis from NTM could not be accurately made based solely on the histological features. However, the airway centered tendency of NTM reflected an airborn etiology, and this could be correlated with the classification according to the radiological findings. In addition, coexisting constitutional lung diseases, and especially bronchiectasis, were suspected to be predisposing conditions for NTM organisms to colonize and progress to true NTM pulmonary disease.

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