Mixed Papilloma Research Articles

134 Solitary Pulmonary Mixed Squamous and Glandular Papilloma: A Case Report and Review of Literature

Solitary pulmonary papilloma can be of squamous, glandular or mixed subtype. Mixed squamous and glandular papilloma of the lung is an extremely rare neoplasm, with only 20 cases reported in the literature. Herein we report an unusual case of peripherally located mixed papilloma in a 71-year-old nonsmoking woman. The patient presented with a three-month history of cough. Chest CT scan with contrast revealed a 4.4 x 2.4 x 2.2 cm heterogeneous spiculated left apical mass with possible pleural involvement. PET/CT scan demonstrated high metabolic activity (SUV 17) suggesting malignancy. Several sub-centimeter-sized mediastinal lymph nodes, some with calcifications were also noted. Metastatic work-up was negative. Fine needle aspiration of the mass showed reactive bronchial epithelial cells and a few inflammatory cells. Left upper lobectomy was performed.On gross inspection, a 4.2 x 3.6 cm solid white tan, ill-defined mass was identified with puckering of overlying pleura. Histology showed an expansile tumor, appearing to arise from an endobronchial location with focally infiltrative growth pattern. The tumor was composed of proliferating papillary tufts lined by squamous epithelium and glandular epithelium with overlying columnar ciliated cells. The adjacent lung showed prominent fibrosis due to tumor expansion and growth with interspersed squamous islands. The tumor cells, both the squamous and glandular components, had minimal cytological atypia with no mitosis or necrosis. The overlying pleura and margins were free of tumor. The tumor cells were positive for CK5/6 and p63 while negative for TTF-1, CK7 and Napsin A, CK20, and P16. Reported cases of pulmonary mixed papilloma have male to female ratio of 3:1, with median age of presentation at sixth decade. Vast majority of these cases are centrally located and endobronchial. Surgical resection is considered curative, with only one case of transformation to squamous cell carcinoma reported.

Respiratory papillomas

Papillomas are known to occur in the lower respiratory tract. They are however, rare compared to their occurrence in the upper respiratory tract. These are generally exophytic tumors in the more proximal upper airways however cases with more distal location with an inverted growth pattern have also been described in the literature. These can be solitary or multiple and multifocality associated with multiple papillomas in the upper respiratory/aerodigestive tract. The four major types of respiratory papillomas are (1) Recurrent respiratory papillomas, (2) solitary squamous papillomas, (3) solitary glandular papillomas, (4) mixed papillomas. We review the incidence, etiopathology, diagnosis, and possible treatment modalities and algorithms for these respiratory papillomas.

A Solitary Mixed Squamous Cell and Glandular Papilloma of the Lung

Mixed squamous cell and glandular papilloma (mixed papilloma) of the lung is exceedingly rare, with only 18 cases reported in the literature. Herein, we report a case of mixed papilloma and its associated immunohistochemical and positron emission tomographic (PET) findings. A 60-year-old Japanese male with a smoking history of 40 pack-years presented with a smooth-edged pulmonary lesion in the right S5 segment on computed tomography (CT). F18-fluorodeoxyglucose (FDG) PET revealed abnormally increased FDG uptake in the mass (maximum standardized uptake value, 3.4). We performed right middle lobectomy and combined partial resection of the S8 segment. The 1.8-cm tumor that filled the enlarged lumen of the B5b was histologically diagnosed as mixed papilloma. Immunohistochemically, the pseudostratified columnar epithelium was positive for cytokeratin (CK) 5/6 and CK7. p40 positivity was predominant in the basal and squamous cells. Thyroid transcription factor-1 and carcinoembryonic antigen were negative on immunostaining. Malignant features were absent. The postoperative course has been uneventful for 3 months after the surgery. No recurrences were reported after the surgical resection of the mixed papilloma. Therefore, surgical resection may be considered the mainstay of curative treatment.

Mixed Squamous Cell and Glandular Papilloma Presented with Peripheral Lung Mass: A Case Report

Mixed squamous cell and glandular papilloma is a rare pulmonary neoplasm typically occurring in the central lung area. Herein, we report a case of peripherally located mixed papilloma in a 54-year-old man with a complaint of dyspnea. Chest computed tomography demonstrated an infiltrative peripheral lung mass in the right middle lobe, measuring 1.5 cm in diameter. The resected lung tumor had papillary configuration lined by both squamous cell epithelium and mucin-containing glandular epithelium. The papillary stroma showed a fibrovascular core with inflammatory infiltrates. p63 immunostaining was positive in basal and parabasal tumor cells in papillary fronds. (J Lung Cancer 2012;11(2):94�� 96)

Mixed squamous cell and glandular papilloma of the lung: A case study and literature review

Mixed squamous cell and glandular papilloma (mixed papilloma) of the lung is an extremely rare neoplasm, with only 10 cases reported so far in the English literature. We present a case study of endobronchial mixed papilloma with immunohistochemical and etiological investigations. A 49-year-old male with a smoking history complained of hemoptysis, presented with a lung mass closely adjacent to large vessels in the computed tomography findings, and underwent lobectomy. The 3.0-cm sized polypoid tumor was histologically diagnosed as endobronchial mixed papilloma. Immunohistochemically, intracellular mucin was positive for MUC5AC, which is expressed in tracheobronchial goblet cells. CAM5.2 and CK19 were diffusely positive, indicating that the tumor originated from the columnar epithelium by squamous metaplasia. CEA and CA19-9 were focally positive. A human papillomavirus (HPV) investigation with in situ hybridization using a wide spectrum probe and a newly-developed PCR system did not detect any HPV infection. Including this case with a detailed HPV investigation, all of the reported cases of mixed papilloma were HPV-negative, and a literature review including newly-reported cases indicated a high frequency of smoking in such cases. Endobronchial mixed papillomas might have a smoking-related etiology.

A solitary bronchial papilloma with unusual endoscopic presentation: case study and literature review

BackgroundSolitary endobronchial papillomas (SEP) are rare tumors and most of them are described by case report. A misdiagnosis is common with viral related papillomas. A histopathological classification has recently permitted a major advancement in the understanding of the disease.Case PresentationWe report a case of a mixed bronchial papilloma with an unusual endoscopic presentation. The literature was extensively reviewed to ascertain the unusual characteristics of the current case. A 39-year of age male was referred to our institution for the investigation of a slight hemoptysis. Routine examination was normal. A fibroscopy revealed an unusual feature of the right main bronchus. The lesion was a plane, non-bleeding, non-glistering sub-mucosal proliferation. No enhanced coloration was noticed. Biopsies revealed a mixed solitary bronchial papilloma. In situ HPV hybridization was negative. Endoscopic treatment (electrocautery) was effective with no relapse.ConclusionThis lesion contrasts with the data of the literature where papilloma were described as wart-like lesions or cauliflower tumors, with symptoms generally related to bronchial obstruction. We advise chest physicians to be cautious with unusually small swollen lesions of the bronchi that may reveal a solitary bronchial papilloma. Endoscopic imaging can significantly contribute to the difficult diagnosis of SEP by pulmonary physicians and endoscopists.

Solitary Pulmonary Papillomas in Adults

Solitary endobronchial papillomas in adults are rare neoplasms. Only sporadic cases have been documented. The histologic classification of these tumors remains problematic, and little is known about their clinical behavior. The clinical and pathologic features of 13 endobronchial papillomas and a single endobronchiolar papilloma were reviewed. In situ hybridization for human papillomavirus (HPV) types 6/11, 16/18, and 31/33/51 was performed on seven cases. Twenty-seven additional well-documented cases were identified in a literature review. Human papillomavirus studies were performed in four of the previously reported cases. The 41 neoplasms combined from the Armed Forces Institute of Pathology and literature review were divided into three groups according to their histologic features. Thirty-one of 41 (76%) patients were men. The ages of the patients ranged from 26 to 74 years (median, 57 years). Three morphologically distinct histologic types were recognized; 27 squamous cell papillomas, 7 glandular papillomas, and 7 mixed squamous and glandular papillomas. Squamous papillomas: 23 of 27 (85%) patients were men, and the median age was 54 years. Six of eleven (55%) of these patients smoked. Twenty-six lesions were exophytic and a single lesion had an inverted pattern. Seven of 24 (29%) lesions featured cytologic atypia and 5 of 24 (14%) had viral cytopathic effect. Five of seven (71%) cases examined for HPV DNA were positive. Three of 18 (17%) recurred. Glandular papillomas: Four of seven (57%) patients were women. The mean age was 67 years. One of five (20%) patients smoked. Five lesions were central, and two were peripheral. Four lesions had columnar epithelium, and three had ciliated epithelium. One of six (17%) lesions recurred. Mixed papillomas: five of seven (71%) patients were men. The median age was 64 years. Three of five (60%) patients smoked. Three of seven (43%) lesions featured cytologic atypia. Four of five lesions were examined for HPV DNA and all were negative. No lesions recurred. This study demonstrates that solitary endobronchial papillomas can be separated into three distinct morphologic categories. Squamous cell and mixed papillomas are predominantly lesions of male smokers in their 6th decade. Although cytologic atypia is observed in many cases, the rarity of these tumors and difficulty in separating papillomas from endobronchial papillary squamous carcinomas make generalizations regarding the risk of progression to carcinoma tenuous at best. Human papillomavirus appears to play a pathogenetic role in some squamous cell papillomas, but not in mixed papillomas, yet its presence in the squamous lesions does not correlate with recurrence or malignancy. The first report of an inverted squamous cell papilloma indicates clinical features similar to the more common exophytic squamous cell papillomas. Glandular papillomas, the rarest of all endobronchial papillomas, are found in an older age group than squamous and mixed papillomas, and most-patients are nonsmokers. Based on these findings, all endobronchial papillomas should be completely excised.

Canine Sweat Gland Growths

A classification of canine sweat gland tumours is presented, based on 30 apocrine growths and 1 merocrine tumour. Seventeen of the apocrine specimens were cysts which were classified into ‘multiple’ or ‘solitary’ types; the definitive cysts apparently resulted from an extreme degree of involutional cystic change following a preceding apocrine epithelial hyperplasia. This process shows histological similarities to mammary cystic hyperplasia. Secondary changes may occur in the cyst lining. Four cases of benign apocrine intracystic papillomata and 5 of apocrine papillary carcinomata are described. All cases were associated with cysts of the solitary or multiple type, and an intracystic origin was demonstrated with all the papillomata and with 3 of the malignant tumours. Except for 1 papilloma, all cases showed a bulky myoepithelial stroma differentiating into mucoid connective tissue and dense collagen. One of the intracystic papillomata showed foci of chondrification in the stroma and was therefore classified as a mixed apocrine papilloma; this appears to be only the fourth recorded case of such a growth. Four cases of benign cylindroma are described; reasons are given for regarding this tumour as a solid apocrine adenoma, and distinguishing it from focal cylindromatous differentiation in a predominantly basal celled carcinoma. A metastasizing merocrine spheroidal celled carcinoma is described; this appears to be the first such neoplasm to be reported in the dog. The breed, age and sex incidences, locations, clinical histories, and macroscopic appearances for each type of growth are presented, and the relevant literature reviewed.