Abstract
BackgroundPulmonary epithelial-myoepithelial carcinoma (P-EMC) is a rare subset of salivary gland-type tumors of the lung. Because of its rarity and unproven malignant potential, the optimal therapy for P-EMC has not been defined. Here, we report a typical case of P-EMC and a review of the literature to consider appropriate treatment.Case presentationA 54-year-old woman presented with an abnormal lung shadow on a routine chest X-ray. A chest computed tomography (CT) scan verified an 18-mm endobronchial nodule on the middle lobe. We performed a bronchoscopic biopsy, and the patient was diagnosed with P-EMC. After confirming the absence of tumors in the salivary glands, she underwent a right middle lobectomy along with hilar and mediastinal lymph node dissections. Currently, the patient is doing well, without any sign of recurrence 3 years after surgery.ConclusionsAlthough a majority of P-EMC cases, as in our case, behave indolently, several poor progression cases have been reported. For distinguishing the minor malignancy cases from others, histological findings such as myoepithelial anaplasia could be a predictive factor. Complete resection is needed to evaluate the whole tumor, because P-EMCs often show histological heterogeneity. Moreover, incomplete excision may be a poor prognostic factor. Although lobectomies as well as lymph node dissections, sleeve lobectomies, or pneumonectomies are routinely performed for complete resection, further investigation is required to establish the optimal treatment strategy.
Highlights
Pulmonary epithelial-myoepithelial carcinoma (P-EMC) is a rare subset of salivary gland-type tumors of the lung
Lobectomies as well as lymph node dissections, sleeve lobectomies, or pneumonectomies are routinely performed for complete resection, further investigation is required to establish the optimal treatment strategy
P-EMC is a tumor characterized by biphasic morphology, consisting of an inner layer of duct-like structures made of epithelial cells and a surrounding layer of myoepithelial cells immunoreactive for S-100 and smooth muscle actin [1]
Summary
We report a case of P-EMC for the rarity. The majority of P-EMCs behave indolently as seen in our case, our review indicates that several P-EMCs progress. Histological findings such as myoepithelial anaplasia could be a predictive factor for distinguishing the minor malignant cases from others. Complete resection is needed to evaluate the whole tumor, since P-EMC usually shows histological heterogeneity and since incomplete excision may be a poor prognostic factor. Lobectomies, as well as lymph node dissections, sleeve lobectomies, or pneumonectomies, have been frequently performed for complete resection of P-EMC. Further investigation is required to establish the optimal treatment strategy
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