MUCOEPIDERMOID CARCINOMA OF LUNG

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Mucoepidermoid carcinoma is a very rare malignancy of lung, originated from minor salivary gland tissue of proximal tracheobronchial tree, affecting mostly young patients, grows as a polyp like growth in central bronchial region CASE PRESENTATION: 22 years old housewife, lactating mother, presented with right sided chest pain, cough with white sputum (single episode of bloody sputum) for 3 months and shortness of breath for 1 month. In Past, she has taken Antituberculous drugs (CAT-1) for 9 months a year ago empirically. On examination she was pale, febrile with respiratory rate of 24 breaths/min. On Chest Examination, respiratory movements decreased on right chest, dull percussion note on right chest from 4th intercostal space downwards with decreased air entry and vocal resonance in the same region. Rest of the systemic examination was normal. Chest x-ray showed right lower zone opacity with cardiac and diaphragmatic silhouette sign positive and shifting of mediastinum to right side, suggestive of collapse. On CBC, TLC was 20.8 (N 87%), ESR 123 mm 1st hour. RFT, LFT normal. Work up for PTB negative. Sputum for routine CS showed heavy growth of Moraxella Catarrhalis, antibiotic according to sensitivity started. CT chest with contrast showed Elongated endobronchial lesion extending from right mainstem bronchus into Bronchus Intermedius, causing obstruction, lobar collapse consolidation of right middle and right lower lobes. Multiple mediastinal and right hilar lymph nodes noted. Bronchoscopy showed large whitish rounded endobronchial growth covered with shiny mucosa obliterating right bronchus intermedius. Endobronchial biopsy for Histopathology showed features consistent with Mucoepidermoid Carcinoma. DISCUSSION: Mucoepidermoid carcinoma is a malignant tumor of bronchial tree comprising about 0.1%-0.2% of all lung cancers. It originates from glandular tissue in submucosa of tracheobronchial tree, occurs in relatively young with equal sex distribution in central bronchial region. Patient may be asymptomatic or can have cough, blood in sputum, shortness of breath or wheezes. On chest x-ray it presents as collapse or consolidation while CT scan shows endobronchial growth with or without collapse and consolidation. On histology it can be cystic, papillary or solid structure consisting of mucus producing cells. It can be of lowgrade (squamous cell predominantly) and highgrade (glandular cells predominantly). Lowgrade Mucoepidermoid carcinoma has better prognosis (5 year survival rate of 95%) than highgrade Mucoepidermoid carcinoma. Radical surgery is the choice of treatment with no adjuvant therapy usually needed. CONCLUSIONS: Mucoepidermoid carcinoma of the bronchus, a rare primary lung malignancy, usually presents with symptoms of airway obstruction and recurrent pneumonia. Therefore this rare entity in patients who are unresponsive to regular treatment should be kept in mind. Reference #1: Kitada et al. Journal of Cardiothoracic Surgery 2011, 6:132 Reference #2: Primary Mucoepidermoid Carcinoma of the Lung, El-Sameed, Yaser Abu MBBS; Al Marzooqi, Saeed H. Journal of Bronchology & Interventional Pulmonology: July 2012 - Volume 19 - Issue 3 - p 203–205 Reference #3: Sujay R. Belgod, Rajashekara H.V. Reddy, and Suma P. Kumar, Oxford Medical Case Reports, 2015 , 203–205 DISCLOSURES: No relevant relationships by Zunair Ahmed Khan, source=Web Response No relevant relationships by Sidra Hameed, source=Web Response No relevant relationships by Faisal Faiyaz Zuberi, source=Web Response