Salivary Gland-type Lung Research Articles

Outcome of primary pulmonary salivary gland-type carcinoma

Abstract Introduction/Objective Primary pulmonary salivary gland-type carcinomas are rare malignancies that arise from minor salivary gland tissue present within seromucinous submucosal glands within the lower respiratory tract. Due to their rarity (~ <1% of all primary lung malignancies), the epidemiological features and outcome of these malignancies are not well documented. Data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database was analyzed to identify cases of primary pulmonary salivary gland carcinoma. The most common tumor types included mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ADCC), and epithelial-myoepithelial carcinoma (EMEC). The tumors were analyzed for overall survival across various epidemiological factors. Methods/Case Report All patients diagnosed with MEC, ADCC, and EMEC with the lung designated as the primary site between the period of 1975 to 2017 were analyzed. We calculated overall survival and disease-specific survival with Kaplan-Meier curves and Cox proportional hazards models using SPSS v25. Results (if a Case Study enter NA) 323 cases of MEC, 284 cases of ADCC, and 6 cases of EMEC diagnosed as primary lung carcinoma were identified. Age distribution analysis of the patients showed a unimodal distribution for both MEC and ADCC with most patients being diagnosed after the age of 40. 54% of MEC patients were male, while 48% of ADCC patients were male. The majority of patients were Caucasians (77% for MEC and 83% for ADCC patients). Both disease-specific and overall survival were worse for patients diagnosed at the age of 60 years or above. Race or sex did not significantly affect patients’ survival. High-grade MEC showed significantly worse prognosis than low or intermediate grade MEC. EMEC cases were too few (n=6) to perform reliable survival analysis, however, the age of diagnosis was higher (45 and above) with a higher incidence among black population (50%). Conclusion Comprehensive review of clinical and epidemiological features of primary salivary gland-type lung carcinoma show that the age of diagnosis and tumor grade are the most significant factor in determining the survival of these patients.

A RARE FORM OF SYNCHRONOUS LUNG CANCER: MUCOEPIDERMOID CARCINOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: We report a unique case of lung cancer involving two different histologic variants. Mucoepidermoid carcinoma (MEC) a salivary gland-type tumor and conventional adenocarcinoma CASE PRESENTATION: The patient in this case study is a 57-year-old male non-smoker with history of hypertension, prostate cancer and deep venous thrombosis, who was incidentally found to have chest x-ray findings concerning for diaphragmatic eventration. Computed tomography (CT) of the chest revealed a linear area of scarring in the left upper lobe and a 5 mm nodule in the left lower lobe (Figure 1, 2). Positron emission tomography-CT (PET-CT) was obtained to evaluate the nodule which revealed a metabolically active 2.8 x 1.5 cm opacity in the left upper lobe, suspicious for malignancy (Figure 3). He underwent CT guided biopsy of the left upper lobe nodule. After the diagnosis, he underwent left Video-Assisted Thoracic Surgery which converted into an open thoracotomy with left upper lobe lobectomy. Microscopic examination revealed that the tumor was located in the peribronchial area of the lung and compromised of two different histologic components: A central MEC component, containing mucin producing cells. The MEC part was negative for cytokeratin 7 (CK7), thyroid transcription factor-1 (TTF-1) and Napsin. The central MEC part of the tumor is surrounded by adenocarcinoma component. The adenocarcinoma component presented with mixed lepidic and acinar patterns positive for TTF-1, Napsin and CK7 but negative for P63 and P40 stains. According to the seventh edition of TNM staging for lung tumors, the clinical stage of this patient was pT2aNO Stage IV. DISCUSSION: Salivary gland-type lung cancers are relatively rare neoplasms of the lung. They represent about 0.1 to 0.2% of primary lung tumors and are detected incidentally. CT findings usually include a well-defined endobronchial mass with or without obstructive pneumonia or atelectasis (1). The genetic analysis of cancer cells is the standard of care in order to select the most effective therapy; however, the genetic characteristics of MEC are not yet fully understood. Mutations in EGFR and ALK genes are routinely tested to identify lung adenocarcinoma patients who could benefit from treatment with target therapies. Treatment of choice is complete surgical excision as its controversial if pulmonary MEC is responsive to chemotherapy and radiotherapy; however, in cases of high-grade PMEC, adjuvant chemotherapy has been reserved when complete resection is impossible. Patients with unresectable disease have responded to EGFR-targeted therapy. CONCLUSIONS: This case report serves to illustrate the rare combination of MEC and adenocarcinoma. Early surgical intervention has shown to be favorable in low-grade MEC; however, further investigation is required to evaluate for the need for adjunct therapy in the future given the risks of developing high-grade MEC and adenocarcinoma. REFERENCE #1: Li X, Zhang W, Wu X, et al. Mucoepidermoid carcinoma of the lung: common findings and unusual appearances on CT. Clin Imaging. 2012;36:8–13. REFERENCE #2: Yousem, S.A. and Hochholzer, L. (1987), Mucoepidermoid tumors of the lung. Cancer, 60: 1346-1352. https://doi.org/10.1002/1097-0142(19870915)60:6<1346::AID-CNCR2820600631>3.0.CO;2-0 REFERENCE #3: Leonardi HK, Jung-Legg Y, Legg MA, Neptune WB. Tracheobronchial mucoepidermoid carcinoma. Clinicopathological features and results of treatment. J Thorac Cardiovasc Surg. 1978;76(4):431–8. DISCLOSURES: No relevant relationships by Chandan Buttar, source=Web Response No relevant relationships by Debra Ferman, source=Web Response No relevant relationships by Sofia Lakhdar, source=Web Response No relevant relationships by Theo Trandafirescu, source=Web Response

AN UNEXPECTED CAUSE OF HEMOPTYSIS: RARE TRACHEAL TUMOR

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Leading causes of hemoptysis in the western world are cryptogenic and infectious. We present a case of a young adult with isolated hemoptysis subsequently found to have a rare tracheal tumor. CASE PRESENTATION: A 24 yo male presented to the emergency room with hemoptysis of 3-4 tablespoons of bright red blood. He is a competitive swimmer with past medical history of childhood L5 osteochondroma and no tobacco use history. He had no other symptoms or exercise limitation. Initial chest x-ray and lab work were normal. Chest CT revealed mid-tracheal pedunculated mass obstructing >50% of the tracheal diameter. He was admitted to the hospital where bronchoscopy was performed, revealing a multilobulated and vascular-appearing mass. The patient proceeded to thoracic surgery with trans-cervical resection of the mass on 1 tracheal ring. Pathology revealed carcinoma ex pleomorphic adenoma with negative margins. The malignant component of the tumor was negative for MAML2 rearrangement by fluorescent in situ hybridization and was best characterized as high-grade adenocarcinoma, not otherwise specified. PET-CT and brain MRI were negative for metastatic disease. He received 60 Gy of adjuvant radiation therapy 8 weeks following resection. DISCUSSION: Primary salivary gland-type (P-SGT) tumors arise from the seromucinous submucosal glands of the central airways, and unlike their salivary gland counterparts, tend to be malignant.3 P-SGT of the lung are rare and account for 0.1-0.2% of all lung cancer. Mucoepidermoid carcinoma is the most common, followed by adenoid cystic carcinoma and distantly followed by epithelial-myoepithelial carcinoma. Carcinoma ex pleomorphic adenocarcinoma (Ca ex PA) is exceedingly rare, with 11 cases reported in the literature (4 involving the trachea). This tumor has an abrupt transition from a benign pleomorphic adenoma with bland ductal and myoepithelial components to a high grade malignant carcinoma with marked atypia, necrosis and mitotic activity. This is in contrast to the majority of P-SGT tumors, which are typically low grade and carry an overall prognosis of 56.3% survival at 20 years. Average age of onset for P-SGT tumors is the 5th and 6th decades, including pulmonary Ca ex PA (mean age 54y), which makes this discovery in a young patient highly unexpected. For P-SGT tumors, surgical intervention results in significant improvement in overall survival. The optimal treatment for pulmonary Ca ex PA remains unknown with the majority of reported cases receiving complete resection with varying adjuvant use of radiation and/or chemotherapy. CONCLUSIONS: Ca ex PA of the large airways is extremely rare and, in contrast to the majority of other primary salivary gland-type tumors, is high grade. Optimal treatment strategies remain unknown with resection plus radiation and/or chemotherapy being the most common approach to date. Reference #1: Ittrich H, Bockhorn M, Klose H, Simon M. The Diagnosis and Treatment of Hemoptysis. Dtsch Arztebl Int. 2017;114(21):371-381. Reference #2: Molina JR, Aubry MC, Lewis JE, et al. Primary salivary gland-type lung cancer: spectrum of clinical presentation, histopathologic and prognostic factors. Cancer. 2007;110(10):2253-2259. Reference #3: Falk N, Weissferdt A, Kalhor N, Moran CA. Primary Pulmonary Salivary Gland-type Tumors: A Review and Update. Adv Anat Pathol. 2016;23(1):13-23. DISCLOSURES: No relevant relationships by Mark Allen, source=Web Response No relevant relationships by Jennifer Boland, source=Web Response No relevant relationships by Matthew Cecchini, source=Web Response No relevant relationships by Kimberly Johnson, source=Web Response no disclosure on file for Tobias Peikert

SALIVARY ADENOID CYSTIC CARCINOMA: AN UNCOMMON SALIVARY-TYPE OF LUNG CANCER

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Adenoid cystic carcinoma (ACC) is a rare salivary gland-type lung malignancy with an estimated incidence of 0.04-0.2% [1]. Tumors typically occur in the major airways and may have submucosal invasion [2]. Common presenting symptoms include chest pain, hemoptysis, and dyspnea. We report a patient with non-specific chest pain found to have primary ACC of the lung. CASE PRESENTATION: A 55-year-old female non-smoker with history of hypertension and diabetes presented with worsening headache, neck, chest, and back pain following a motor vehicle accident four days prior. She further clarified that she had been experiencing left-sided chest pain radiating to her left shoulder for one year. Physical examination was remarkable only for midline neck and back tenderness. Initial labs were unremarkable. Chest radiography identified a left sided suprahilar opacity. This prompted a computed tomography (CT) scan of her chest which demonstrated a 2.9 x 2.3cm left sided suprahilar mass with splaying of the underlying vascular structures [Figure 1A]. Positron emission tomography CT scan showed avid fluorodeoxyglucose uptake in the left upper lobe [Figure 1B]. Bronchoscopy was performed which revealed a smooth mass within the left main bronchus that had increased vascularity with narrow band imaging [Figure 2]. Endobronchial biopsies confirmed ACC and prompted referral for a left upper lobe lobectomy. Pathological analysis was consistent with a Grade II, moderately differentiated adenoid cystic carcinoma. Surgical margins and 0/23 lymph nodes were negative for malignancy. She was ultimately staged pT2N0M0 with an R0 resection. On follow-up with hematology-oncology, it was determined that the patient would not require adjuvant chemoradiation. She remains on active surveillance without any evidence of tumor recurrence at 12-month follow-up. DISCUSSION: Diagnosis and staging for ACC requires a combination of radiographic imaging and bronchoscopy with biopsy. Histological sub-types include cribriform, tubular, and solid, the latter being more aggressive [2]. Surgical resection is the cornerstone of management providing the best prognosis. A case series of 26 patients who underwent R0 surgical resection of primary ACC observed an overall survival rate of 91.7% at 5-years [3]. A similar benefit was also seen with adjuvant radiotherapy in R1 resections. In those who are not surgical candidates, survival is 0% at 5-years. In non-surgical patients, chemoradiation is often ineffective as ACC responds poorly to currently available chemotherapeutics. CONCLUSIONS: ACC is an uncommon type of lung cancer. Tumors have a high likelihood of submucosal extension and local recurrence. Complete surgical resection offers the best prognosis. In contrast, chemoradiation has a limited role in non-surgical candidates. Reference #1: W. D. Travis, L. B. Travis, and S. S. Devesa, “Lung cancer,” Cancer, vol. 75, no. 1 S, pp. 191–202, 1995, doi: 10.1002/1097-0142(19950101)75:1+<191::AID-CNCR2820751307>3.0.CO;2-Y. Reference #2: H. Inoue, A. Iwashita, H. Kanegae, K. Higuchi, Y. Fujinaga, and I. Matsumoto, “Peripheral pulmonary adenoid cystic carcinoma with substantial submucosal extension to the proximal bronchus,” Thorax, vol. 46, no. 2, pp. 147–148, 1991, doi: 10.1136/thx.46.2.147. Reference #3: M. M. Hu, Y. Hu, J. B. He, and B. L. Li, “Primary adenoid cystic carcinoma of the lung: Clinicopathological features, treatment and results,” Oncol. Lett., vol. 9, no. 3, pp. 1475–1481, Mar. 2015, doi: 10.3892/ol.2015.2859. DISCLOSURES: No relevant relationships by Ethan Karle, source=Web Response No relevant relationships by Armin Krvavac, source=Web Response No relevant relationships by Michael Nance, source=Web Response No relevant relationships by Tarang Patel, source=Web Response

(18)F-fluorodeoxy glucose positron emission tomography/computed tomography manifestation and clinical characteristics of primary salivary gland-type lung cancer

Objective: To explore the imaging manifestation and clinical characteristics of primary salivary gland-type lung cancer using (18)F-fluorodeoxy glucose ((18)F-FDG) positron emission tomography/computed tomography (PET-CT). Methods: From March 2009 to January 2017, 12 patients with pathologically confirmed primary salivary gland-type lung cancer were enrolled in First Affiliated Hospital of Nanjing Medical University. Their images and clinicopathological data were retrospectively analyzed. Results: Six out of 12 patients had mucoepidermoid carcinoma (MEC), and the other six patients had adenoid cystic carcinoma (ACC). Five MEC were located in the main bronchus, and the other one was in segmental bronchus. Intrabronchial nodule or mass with smooth or lobulated margin and calcification(n=3) was the main (18)F-FDG PET-CT features of MEC. Two ACC involved trachea, two involved the main bronchi, and the other two involved lobular bronchi. The main (18)F-FDG PET-CT features of ACC were diffuse or circumferential irregular thickness of the bronchial wall, distorted lumen, and the longitudinal extent of the tumor was greater than its transverse axis. The (18)F-FDG uptake of all lesions was increased in varying degree. The median (25th percentile, 75th percentile) value of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were 5.1(3.1, 8.1), 5.7(1.2, 21.4)cm(3) and 18.6(0.6, 93.7), respectively. All of them were related to pathological grading and nodal tumor involvement( all P<0.05), but not associated with tumor location or pathological type( all P>0.05). MTV and TLG were also related to clinical stage( all P<0.05). Tumor size was correlated with MTV, TLG of primary lesions(r=0.607, P=0.036; r=0.579, P=0.049), but not with SUVmax(r=0.568, P=0.054). Conclusions: Primary salivary gland-type lung cancer mainly occurs in segmental bronchus. The MTV and TLG of the tumor calculated by (18)F-FDG PET-CT are correlated with clinicopathological characteristics, and are helpful for clinical diagnosis and treatment.

A Comparative Study of Primary Adenoid Cystic and Mucoepidermoid Carcinoma of Lung.

Pulmonary mucoepidermoid carcinoma (PMEC) and pulmonary adenoid cystic carcinoma (PACC) are the two major types of primary salivary gland-type (PSGT) lung cancers. The demographic profile, clinicopathological features, and predictors of survival as an overall group have not been described for PSGT cancers of lung. In this study, we analyzed demographic, clinical, and survival data from 1,032 patients (546 PMEC and 486 PACC) who were diagnosed of PSGT lung cancer in the Surveillance, Epidemiology and End Results database from 1973 to 2014. The PSGT constituted 0.09% of all lung cancers with age-adjusted incidence rate of 0.07 per 100,000 person-years and change of -32% from 1973 to 2014. The incidence of PMEC was slightly higher than PACC but there were no differences in the age and sex distribution. PACCs (55%) were significantly higher at trachea and main bronchus while PMECs were more common at peripheral lungs (85%). Most of the tumors were diagnosed at an early stage and were low grade irrespective of histology. As compared to PMEC, significantly higher number of patients with PACC underwent radical surgery and received adjuvant radiation. The 1- and 5-year cause-specific survival was 76.6 and 62.8%, respectively. On multivariate analysis, the survival was affected by age at diagnosis, tumor stage, histological grade, period of diagnosis, and surgical resection. The histology showed strong interaction with time and hazard ratio of patients with PACC was significantly worse than patients with PMEC only after 5 years. The incidence of pulmonary PSGT cancer is 7 cases per 10 million population in the United States and is decreasing. There was no difference between demographic profile of patients with PMEC and PACC but pathological features were diverse. The difference in the survival of patients with the two histological types surfaced only after 5 years when survival of patients with PMEC was better than PACC.

Primary Pulmonary Mucoepidermoid Carcinoma: Histopathological and Moleculargenetic Studies of 26 Cases.

IntroductionPulmonary mucoepidermoid carcinoma (PMEC) is an uncommon neoplasm of the lung and the main salivary gland-type lung carcinoma. The aims of this study were to review the clinicopathological and immunohistochemical features of PMEC and characterize the genetic events in PMEC.MethodsWe reviewed the pathology cases in our hospital and found 34 initially diagnosed PMEC cases, 26 of which were confirmed as PMEC after excluding 8 cases of MEC-like pulmonary carcinoma. The clinicopathological characteristics of the 26 PMEC cases and the 8 cases of MEC-like pulmonary carcinoma were retrospectively reviewed. MAML2 rearrangement was detected by fluorescence In Situ Hybridization (FISH). Immunostains of ALK, calponin, collagen IV, CK7, EGFR, HER2, Ki-67, Muc5Ac, p63, p40, and TTF-1 were performed. DNA was extracted from 23 cases of PMEC. Mutation profiling of the EGFR, KRAS, BRAF, ALK, PIK3CA, PDGFRA, and DDR2 genes were carried out using next-generation sequencing (NGS), Sanger sequencing, and quantitative polymerase chain reaction (QPCR) in 9 successfully amplified cases.ResultsTwenty-six cases of PMEC (18 low-grade, 8 high-grade) included 13 men and 13 women aged 12–79 years. Twenty-two cases had a central/endobronchial growth pattern, and 4 cases had a peribronchial growth pattern. Immunohistochemically, CK7, Muc5Ac, p40, and p63 were positive in all cases (26/26);EGFR was positive in 11 cases (11/26); TTF-1, Calponin, HER2 and ALK were negative in all cases (0/26). MAML2 rearrangement was identified in 12 of 18 PMEC cases. No mutations were detected in any of the 7 genes in the 9 cases that qualified for mutation analysis. Twenty-three PMEC patients had follow-up information with a median interval of 32.6 months. Both the 5- and 10-year overall survival rates (OS) were 72.1%, and a high-grade tumor was an adverse prognostic factor in PMEC. There were 8 cases of MEC-like pulmonary carcinoma aged 36–78 years: 2 cases were located in the bronchus, and 6 cases were located in the lung. p63 and TTF-1 were positive in all cases (8/8), p40 was positive in 5 cases (5/8), and ALK was positive in 5 cases (5/8). No cases of MAML2 rearrangement were detected, but there were 5 cases of ALK rearrangement.ConclusionsPMEC is a primary malignant pulmonary tumor with a relatively good prognosis that is historically characterized by the presence of mucous cells and a lack of keratinization. There are distinct differences between PMEC and MEC-like pulmonary carcinoma in tumor location preference, immunophenotype, and molecular genetics, and the differential diagnosis is critical due to the therapeutic and prognostic considerations.

Molecular genetic studies on EGFR, KRAS, BRAF, ALK, PIK3CA, PDGFRA, and DDR2 in primary pulmonary adenoid cystic carcinoma.

BackgroundPulmonary adenoid cystic carcinoma (PACC) is an uncommon neoplasm of the lung but represents the predominant type of salivary gland-type lung carcinoma. Only a few studies have focused on the genetic events associated with PACC. The aim of this study was to characterize the genetic events associated with PACC.FindingsWe reviewed 24 cases of primary PACC between 2000 and 2014, including 21 cases reported in our previous study and three new cases added in 2014. Mutation profiling of the EGFR, KRAS, BRAF, ALK, PIK3CA, PDGFRA, and DDR2 genes was performed using next-generation sequencing, Sanger sequencing, and quantitative polymerase chain reaction in 9 successfully amplified cases. The 24 cases of PACC included 7 men and 17 women, aged 24–74 years (mean, 50.8 years). All the cases were located in the trachea or bronchus. No mutations were detected in any of the seven genes in the nine cases that qualified for mutation analysis, and the results using different methods were consistent.ConclusionsThe data presented in this work suggest that EGFR, KRAS, BRAF, ALK, PIK3CA, PDGFRA, and DDR2 may not be driver genes in primary pulmonary adenoid cystic carcinoma.

Diagnosis value of TTF-1, Napsin A and Ki-67 index in primary salivary gland-type lung carcinomas

To study the clinicopathologic characteristics of primary salivary gland-type lung carcinomas, and the immunophenotypic value of TTF-1, Napsin A and Ki-67 in their differential diagnosis. Totally 48 special type lung cancer surgical removal specimens were collected in China-Japan Friendship Hospital during September 2009 to December 2014. A panel of immunohistochemical markers (TTF-1, Napsin A, Ki-67, CK5/6, CK7 and p63) were conducted on these specimens. The 48 cases of special type lung cancer included 25 cases of primary salivary gland-type lung carcinoma (18 cases of adenoid cystic carcinoma and 7 cases of mucoepidermoid carcinoma), 5 cases pulmonary adenocarcinoma with mucoepidermoid carcinoma-like or adenoid cystic carcinoma-like structure, and 18 cases of pulmonary adenosquamous carcinoma. Compared with pulmonary adenocarcinoma with mucoepidermoid carcinoma-like or adenoid cystic carcinoma-like structure and pulmonary adenosquamous carcinoma, primary salivary gland-type lung carcinomas have special characteristics in median age, sex, location, tumor size, LN involvement and pleura invasion, with negative TTF-1 and Napsin A expression as well as lower Ki-67 index detected by immunohistochemistry. Primary salivary gland-type lung carcinomas usually have an indolent behavior. Primary salivary gland-type lung carcinomas are low-aggressive entities. The origins of primary salivary gland-type lung carcinomas were different from that of pulmonary adenocarcinoma with mucoepidermoid carcinoma-like or adenoid cystic carcinoma-like structure and pulmonary adenosquamous carcinoma. Negative TTF-1 and Napsin A expression as well as Ki-67 index lower than 20% have special value for primary salivary gland-type lung carcinomas in their differential diagnosis.

Primary Salivary Gland–Type Lung Cancer: Clinicopathological Analysis of 88 Cases from China

Salivary gland-type cancers are rare lung neoplasms involving mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ACC), and epithelial-myoepithelial carcinoma (EMC). Their behavior and prognostic features are not clearly defined because of their low incidence. We retrospectively analyzed the clinicopathologic profiles of these tumors in a large series. Eighty-eight patients confirmed as having primary salivary gland-type lung cancer between May 2001 and January 2013 were included from the archives of two thoracic oncology center institutions in China and retrospectively evaluated. Of the total 88 patients, 69 were MEC, 12 ACC, and seven EMC. Overall survival (OS) at 3, 5, and 10 years was 91.3%, 86%, and 80.6% in all cases, respectively, and disease-free survival (DFS) was 90.1%, 78.6%, and 55%, respectively. No significant difference was found among MEC, ACC, and EMC groups regarding OS (p = 0.518) and DFS (p = 0.082). Tumor-node-metastasis stage, lymph node involvement, intrathoracic invasion, and margin status were found to be related with OS (p = 0.000, 0.029, 0.000, 0.004) and DFS (p = 0.018, 0.042, 0.002, 0.002). Intrathoracic invasion was an independent predictor for OS (hazard ratio [HR], 1.129; p = 0.039) and DFS (HR, 1.071; p = 0.011). For patients with MEC, pathological grade also was an independent predictor of OS (HR, 0.045; p = 0.006) and DFS (HR, 0.067; p = 0.001). Salivary gland-type lung cancers are a group of low-aggressive entities with higher tendency to recurrence/metastasis. Intensive clinical, radiological, and pathological examinations are essential to estimation of the risk stratification and management.

Are the presenting characteristics and prognosis of primary salivary gland-type lung cancers (SG) similar to those of other non-small cell lung cancers (NSCLC)?

7054 Background: SG, both adenoid cystic (ACC) and mucoepidermoid (ME) sub-types, are rare lung cancers. We choose to investigate the incidence of these rare sub-types and assess their difference in presentation and prognostic characteristics in comparison to adenocarcinomas (Ad) and squamous cell carcinomas (SCC) during the same time period. Methods: The SEER-17 database was used to collect data during the years 1988-2008. Differences between populations were determined by the chi-square test. Survival curves were generated as Kaplan-Meier techniques. Cox proportional hazards test was used to compare survival differences. Results: During the 20-year study period, ACC (n =100) and ME (n= 178) accounted for 0.03% and 0.06% of NSCLCs. Mean follow-up was 34.5 months for all patients. In comparison to ACC, patients with ME were significantly more likely to be younger (52 yr vs. 60yr), Asian(11.7% vs. 7%), have Stage I disease (62.9% vs 24.0%), and less likely to be in the mainstem bronchi (17.2% vs. 6.3%). In comparison to patients with patients presenting with either SCC or Ad, both ME and ACC were significantly less likely to present with Stage IV disease (26.6% SCC, 41.29% Ad, 16.73% SG), have nodal involvement (35.1% SCC, 27.4% Ad, 23.37% SG), and be older (70 SCC, 68 Ad, 58 years SG). Stratified by stage and treatment, there was no survival (OS) or disease-specific survival difference (DSS) between ACC and ME. The OS of the combined group of ME and ACC was significantly better stage per stage than either Ad (Hazard ratio (HR) range = 0.26- 041), and SCC (HR range = 0.17-0.56). Lung Cancer-Specific survival at 2,3,5 years for surgically-resected Stage I ACC and ME were 83.5%, 80.4%, and 80.4%; and 82.6%, 78.0% and 78%, respectively. Conclusions: Patients with ACC and ME have rare sub-types of lung cancer that present differently and have better survival than patients presenting with either of the more common histologic sub-types (SCC and Ad) of NSCLC. We encourage prospective, multi-institutional studies of these rare sub-types so that care can be optimized. Optimal care may differ for SG because of their stage per stage better prognosis than other NSCLCs.

CT characteristics of primary salivary gland-type lung cancer

To improve the diagnostic accuracy of primary salivary gland-type lung cancer on CT. The CT findings of 13 pathologically proven primary salivary gland-type lung cancers (mucoepidermoid carcinoma, n = 8, adenoid cystic carcinoma, n = 5) were retrospectively analyzed. Three mucoepidermoid carcinomas were located in the main bronchus, 4 in segmental bronchus, and 1 in peripheral lung. Intrabronchial nodule or mass with smooth or lobulated margin and punctuate or strip calcification (n = 2) was the main CT feature. The tumor showed moderate to significant enhancement after the administration of contrast medium. Three adenoid cystic carcinomas involved trachea, and 2 involved the main and lobular bronchi. The main CT features were diffuse or circumferential irregular thickness of the wall, distorted lumen, and nodule protruding into the lumen, and the longitudinal extent of the tumor was greater than its transverse axis. The CT findings of primary salivary gland-type lung cancer are rather specific and may provide helpful information for the clinical diagnosis and treatment.

Primary salivary gland-type lung cancer: Surgical outcomes

Primary salivary gland-type lung cancer is rare, and little is known about the role of surgery. The aim of this study was to analyze surgical role and outcome for primary salivary gland-type lung cancer. Between October 1995 and June 2008, 48 patients underwent surgical treatment for primary salivary gland-type lung cancer. Medical records were analyzed for age, sex, tumor histopathology, location, surgical resection, tumor grade, clinical outcome, and survival. There were 31 male and 17 female patients, with an average age of 41.1 ± 15.2 years. Mucoepidermoid carcinoma was diagnosed in 26 patients, adenoid cystic carcinoma was diagnosed in 20 patients, and epithelial–myoepithelial carcinoma was diagnosed in 2 patients. The operative procedure included (bi) lobectomy ( n = 15, 31.2%), sleeve lobectomy ( n = 13, 27.1%), tracheal resection ( n = 8, 16.7%), pneumonectomy ( n = 7, 14.6%), and carinal resection ( n = 5, 10.4%). There was no operative mortality, and minor morbidity occurred in eight patients. Incomplete resection occurred in eight patients, and six of them received postoperative radiotherapy. Of incompletely resected patients, cancer recurrence was found in three patients, and all were in the adjuvant radiotherapy group. Overall, cancer recurred in 11 patients (22.9%), and 4 of them were treated by repeated surgical resection and were alive and disease-free at the conclusion of this study. The overall 5-year and 10-year survival rates after operation were 97.6 and 86.7%. Surgical resection of primary salivary gland-type lung cancer was an effective treatment with low operative morbidity, and expected long-term survival. Repeated surgical resection may be considered an effective treatment modality in some cases of recurrence.

Salivary gland-type lung carcinomas: an EGFR immunohistochemical, molecular genetic, and mutational analysis study

Salivary gland-type lung carcinomas are uncommon neoplasms of the lung, the two most common being adenoid cystic carcinoma and mucoepidermoid carcinoma. Although they usually have an indolent behavior, adenoid cystic carcinomas can be more aggressive, with 5-year survival as low as 55%. Unfortunately, these tumors do not respond well to chemotherapy. In contrast to the most common subtypes of lung carcinomas, epidermal growth factor receptor studies have not been carried out in this group of tumors. Herein we report a series of 24 cases (12 adenoid cystic and 12 mucoepidermoid carcinomas) tested for epidermal growth factor receptor protein expression, epidermal growth factor receptor gene copy gains, and epidermal growth factor receptor gene mutational status, through immunohistochemistry, fluorescence in situ hybridization, and sequencing of the exons 18–21, respectively. Overall, 91 and 92% of the adenoid cystic carcinomas and mucoepidermoid carcinomas expressed epidermal growth factor receptor protein. Chromosome 7 polysomy occurred in 25% of the cases (four adenoid cystic carcinomas and two mucoepidermoid carcinomas). No epidermal growth factor receptor gene amplification was detected and no mutation was found in exons 18–21 of the epidermal growth factor receptor gene. Immunoexpression of epidermal growth factor receptor in salivary gland-type lung carcinomas is not related to epidermal growth factor receptor gene copy number or mutational status.