Primary pulmonary adenoid cystic carcinoma: Report of a case diagnosed by fine‐needle aspiration cytology

Abstract

Adenoid cystic carcinoma of the lower respiratory tract is an uncommon tumor that can arise in the mainstem bronchus and often presents as an endobronchial mass lesion causing bronchial obstruction with post obstructive atelectasis and pneumonia. Exfoliative cytology is seldom useful in the diagnosis of primary bronchial adenoid cystic carcinoma, because these neoplasms usually have a submucosal location with often intact mucosa. Since most endobronchial adenoid cystic carcinomas are endoscopically visible, bronchoscope-guided fine-needle aspiration constitutes an excellent approach to establish a pathologic diagnosis. The fine-needle aspiration cytology of primary pulmonary adenoid cystic carcinoma has been rarely described. We report a case of primary adenoid cystic carcinoma of the lung having characteristic cytologic features and correlate with computed tomography, bronchoscopic, and histological findings. Bronchoscope-guided aspiration cytology provided a conclusive diagnosis of adenoid cystic carcinoma, which was further corroborated by histology in the pneumonectomy specimen. Diagn. Cytopathol. 2004;30:51-56.

Primary Peripheral Adenoid Cystic Carcinoma of the Lung and Literature Comparison of Features

“…Thus, we considered that the lung tumor could have been a single distant metastasis. Distinguishing primary from metastatic lung ACC based on cytomorphology or histology is difficult (9). A single endobronchial mass is merely evidence of primary disease.…”

Fine Needle Aspiration Cytopathology of Primary Solid Adenoid Cystic Carcinoma of the Lung

“…Primary ACC beyond the salivary gland has been documented in such secretory glands as the skin, lacrimal glands and breast, in addition to the uterine cervix and lung. 1,5 On the other hand, the lung is the most common site of metastasis of primary ACC of the salivary gland. 6 ACC is usually a slow-growing, locally infiltrative malignancy, which in the lung is thought to arise from ductal myoepithelial cells of the submucosal minor salivary-type glands lining the bronchi.…”

“…Bronchoscopeguided fine needle aspiration (FNA) is an excellent approach to establish a pathologic diagnosis because most endobronchial ACCs are endoscopically visible. 1,2 We report a case of primary ACC of the lung, of the solid and poorly differentiated type. Bronchoscope-guided aspiration cytopathology provided a suggestive diagnosis of ACC, which was further corroborated by histopathology in the pneumonectomy specimen.…”

“…To the best of our knowledge the FNA cytopathology of pulmonary ACC has been described very rarely, with 6 cases primary in the lung, none of them being the solid type of ACC. [1][2][3][4] We report on the FNA findings of a case of primary ACC of the lung that demonstrated a predominantly solid, poorly differentiated pattern, an unusual but well-recognized subtype associated with a poor clinical outcome. …”

“…1,2 Although ACC is the most common type of salivary gland-like tumor occuring in the lung, the cytopathology of primary pulmonary ACC has been rarely described. 1 ACC often arises in the mainstem bronchus and presents as an endobronchial mass lesion causing bronchial obstruction with secondary obstructive atelectasis and pneumonia. Because these neoplasms usually have a submucosal location with often intact mucosa, exfoliative cytology is seldom useful in the diagnosis of primary bronchial ACC.…”