Bronchial adenoma with polymorphous features

BRONCHIAL ADENOMA WITH POLYMORPHOUS FEATURES MOHAMMED AKHTAR, MD,* IRVING YOUNG,M D , ~AND FRANCISCO REYES,M

D ~

A bronchial adenoma from a 35-year-old man presented a unique histologic appearance as it had a prominent papillary pattern and contained ciliated tumor cells. The tumor also contained areas resembling several histologically distinct subtypes of bronchial adenoma, thus indicating a close histogenetic relationship among these subtypes. The significance of cells resembling oncocytes, noted in this tumor, is discussed. It is suggested that the cells which fulfill the light microscopic criteria of oncocytes should be tentatively called oncocytoid cells, and only those cells in which mitochondria1 hyperplasia can be demonstrated by electron microscopy should be designated as oncocytes. Cancer 33:1572-1576, 1974.

A

VARIETY OF UNCOMMON PULMONARY NEO-

plasms, including carcinoid tumors, adenoid cystic carcinomas, mucoepidermoid carcinomas and oncocytomas traditionally has been grouped under the term “bronchial adenoma.”3~4,8J6Less commonly mentioned in this group, although perhaps more properly called adenomas, are benign mixed tumors of the bronchusll and the mucus gland adenomas.7 This paper describes a tumor which had the gross morphological features of a bronchial adenoma, in which the histologic picture is unique by virtue of a conspicuous admixture of cell types in a manner not hitherto described. CASEREPORT

A 35-year-old Caucasion man was found to have a well-circumscribed lesion in the upper lobe of the right lung on routine roentgencgram of the chest. He gave no history of respiratory symptoms and was a non-smoker. O n bronchoscopy, the lesion was inaccessible to view or biopsy. A right upper lobectomy was performed, and following surgery, a course of radiotherapy was instituted. T h e patient is alive and well with n o evidence of locally recurrent or metastatic tumor 3 ‘/2 years after surgery. From the Department of Pathology, Albert Einstein Medical Center, Northern Division, Philadelphia, Pa. * Attending Pathologist. t Director of Laboratories. $ Senior Pathology Resident. Address for reprints: M. Akhtar, MD, Department of Pathology, Albert Einstein Medical Center, York and Tabor Rds., Philadelphia, PA 19141. Received for publication September 7, 1973.

Gross Pathologic Findings

T h e specimen consisted of the upper lobe of right lung resected immediately proximal to the bifurcation of the upper lobe bronchus. T h e posterior segmental branch of the upper lobe bronchus was expanded and completely occluded by a well-circumscribed 2.5 x 2 x 2 cm tumor which was partly endobronchial and partly extrabronchial. It had a yellow-tan cut surface with a few small, soft, dark red areas. T h e endobronchial surface of the tumor was smooth and light yellow; the extrabronchial part of the tumor was surrounded by lung tissue which was compressed but not infiltrated by the tumor (Fig. 1). Microscopic Findings A major part of the tumor was composed of prominent papillary structures consisting of tumor epithelium arranged on fibrovascular stalks. T h e tumor cells were mostly columnar and contained ovoid, slightly hyperchromatic nuclei and finely granular slightly eosinophilic cytoplasm (Fig. 2). Other areas revealed closely packed glands lined by tumor cells of similar morpholo