Adenoid cystic carcinoma of the peripheral lung: a case report
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Adenoid cystic carcinoma of the peripheral lung: a case report Masahiro Kitada1*, Keisuke Ozawa1, Kazuhiro Sato1, Satoshi Hayashi1, Yoshihiko Tokusashi2, Naoyuki Miyokawa2, Tadahiro Sasajima1
Abstract Adenoid cystic carcinoma of the peripheral lung is a rare entity. We recently encountered a patient with adenoid cystic carcinoma. A 75-year-old woman showed a nodular lesion with 10 mm in diameter in the right upper lung field on chest radiography. The diagnosis was unclear, but lung cancer could not be ruled out. Thoracoscopic biopsy was performed, and intraoperative pathological diagnosis revealed the carcinoma of the lung. We enforced upper lobectomy and mediastinal lymph node dissection to the patient. Histopathological examination revealed adenoid cystic carcinoma with a characteristic cribriform structure. Immunohistochemical examination revealed that the tumor cells were positive for thyroid transcription factor 1 (TTF-1), this tumor was diagnosed primary ACC of the lung. Background Adenoid cystic carcinoma (ACC) of the lung is a relatively rare lung cancer arising from the bronchial glands and accounting for about 0.04-0.2% of all lung cancers [1,2]. ACC has a slow growing and prolonged clinical course, and thus is considered a low-grade malignancy. The site of origin is the tracheobronchial glands, so ACC is more common in the central bronchi than in the segmental bronchi. Reports of ACC originating in the peripheral lung are rare. In addition, in cases of occurrence in the periphery, lung metastases from a salivary gland tumor must be ruled out. It reports a case of ACC which we experienced. Case A 75-year-old woman showed a nodular lesion in the right upper lung field on the chest radiography with 6 mm diameter. After 1 year of observation, follow-up chest radiography showed an increase in size to 10 mm. In the thorough examination of the bronchoscope, the definitive diagnosis wasn’t on, so the patient was introduced to our department for diagnosis and treatment. Past medical history included hypertension and diabetes mellitus treated with oral medications. In addition, * Correspondence: [email protected] 1 Department of Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1 Asahikawa Hokkaido 078-8510, Japan Full list of author information is available at the end of the article
a salivary gland tumor had been resected 19 years ago, but details were unknown. Family history was unremarkable, and she had never been a smoker. Her height was 149 cm, the weight was 44 kg, hers blood pressure was 135/91 mmHg and hers heart rate was 65 beats/ min (normal sinus rate). She had no abnormal findings during the physical examination. The biochemical examination of blood did not revealed abnormalities, and levels of tumor markers carcinoembryonic antigen (CEA) was 2.9 ng/ml, squamous cell carcinoma antigen (SCC) was 0.6 ng/ml, Cyfra21-1/cytokeratin 19 fragment (CYFRA) 0.96 ng/ml, and neuron-specific enolase (NSE) was 3.2 ng/ml. Pulmonary
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