Journal of Thoracic Oncology:
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Giant Alveolar Adenoma Causing Severe Dyspnoea
Petrella, Francesco MD*; Rizzo, Stefania MD†; Pelosi, Giuseppe MD‡§; Borri, Alessandro MD*; Galetta, Domenico MD, PhD*; Gasparri, Roberto MD*; Solli, Piergiorgio MD, PhD*; Veronesi, Giulia MD*; Spaggiari, Lorenzo MD, PhD*§
Divisions of *Thoracic Surgery, †Radiology, and ‡Pathology and Laboratory Medicine, European Institute of Oncology; and §University of Milan School of Medicine, Milan, Italy.
Disclosure: The authors declare no conflicts of interest.
Address for correspondence: Francesco Petrella, MD, Department of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. E-mail: firstname.lastname@example.org
A 38-year-old Caucasian woman was admitted to hospital complaining of recent-onset acute night dyspnoea. A chest radiograph disclosed a bulky cystic lesion in the middle-lower field of the left lung (Figure 1), and a computed tomography scan confirmed the presence of a 91 × 50 × 98-mm multiseptated giant cystic mass arising in the lingula and compressing the adjacent pulmonary parenchyma (Figure 2).
The patient's clinical history was unremarkable apart from autoimmune hyperthyroidism under medical treatment for 4 years. The patient underwent left muscle sparing thoracotomy with resection of the entire unopened lesion and no lung tissue sacrifice.
Grossly, the tumor consisted of a multiseptated giant cystic mass with gaseous content and scant liquid material (Figure 3). Histologically, it featured a typical alveolar adenoma with dual cell composition of type II pneumocytes and elongated septal mesenchymal cells, but with unusual formation of giant cystic spaces (Figures 4A, B). The immunohistochemical profile—positivity for thyroid transcription factor-1 (Figure 4C), negativity for myogenin, surfactant and cytokeratins in pneumocytes, and negativity for desmin in mesenchymal cells—was consistent with alveolar adenoma. The proliferative activity as assessed by Ki-67 immunostaining was unremarkable in both cell types (Figure 4D).
The nonrandom occurrence of specific genetic alterations in alveolar adenoma in relation to its neoplastic nature, albeit benign, inasmuch as recurrence has never been recorded.1–4
Most patients are middle aged to elderly and asymptomatic, with a slight female predominance. Most tumors are found by chance, whereas the occurrence of severe tumor-related symptoms, as described in our case, is exceptional. Conservative surgery is the best treatment and no further therapy is required.2
1. Sak SD, Koseoglu RD, Demirag F, et al. Alveolar adenoma of the lung. Immunohistochemical and flow cytometric characteristics of two new cases and a review of the literature. APMIS 2007;115:1443–1449.
2. Halldorsson A, Dissanaike S, Kaye KS. Alveolar adenoma of the lung: a clinicopathological description of a case of this very unusual tumour. J Clin Pathol 2005;58:1211–1214.
3. Cavazza A, Paci M, De Marco L, et al. Alveolar adenoma of the lung: a clinicopathologic, immunohistochemical, and molecular study of an unusual case. Int J Surg Pathol 2004;12:155–159.
4. Roque L, Oliveira P, Martins C, et al. A nonbalanced translocation (10;16) demonstrated by FISH analysis in a case of alveolar adenoma of the lung. Cancer Genet Cytogenet 1996;89:34–37.
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