Sun Jiaen, Zhao Weidi, Zhang Chong, Zheng Enkuo, Jiang Xu, Wang Li, Hayashi Takuo, Sasaki Eiichi, Tachibana Mitsuhiro, Zhao Guofang
Department of Thoracic Surgery, Ningbo No. 2 Hospital, Ningbo, China.
Health Science Center, Ningbo University, Ningbo, China.
Transl Lung Cancer Res. 2023 Jul 31;12(7):1611-1624. doi: 10.21037/tlcr-23-374. Epub 2023 Jul 25.
Bronchiolar adenoma (BA)/ciliated muconodular papillary tumor (CMPT) is a rare lung tumor characterized by ciliated, mucous and basal cells. Recently, some cases of driver mutations or malignant transformations have been reported. However, the nature of BA/CMPT remains controversial. Here, we report a case of bilateral pulmonary multiple BAs with tumor budding and squamous metaplasia.
A 55-year-old man presented with multiple small nodules in the lower lobes of the bilateral lungs on physical examination 7 years prior. During the past 3 years of regular follow-up, some nodules had slightly enlarged. Because the nodules were mostly solid, the patient underwent video-assisted thoracoscopic segmentectomy of the left lower lung. A postoperative pathological diagnosis of BA was made. In all lesions, the fusion and mutation of major driver genes were not detected by next-generation sequencing (NGS). No recurrence or metastasis was observed after 37 months of follow-up. Notably, all five resected lesions were BA/CMPT, and one lesion was accompanied by squamous metaplasia and tumor budding.
Our report found that BA/CMPT with squamous metaplasia and tumor budding has the potential to transform into lung squamous cell carcinoma, expanding its connection with malignant transformation. Smoking may be one of the risk factors. We also found that BA/CMPT can be multiple lesions rather than a solitary lesion.
细支气管腺瘤（BA）/纤毛黏液结节状乳头状瘤（CMPT）是一种罕见的肺肿瘤，其特征为纤毛细胞、黏液细胞和基底细胞。最近，有一些关于驱动基因突变或恶性转化的病例报道。然而，BA/CMPT的性质仍存在争议。在此，我们报告一例双侧肺多发BA伴肿瘤芽生和鳞状化生的病例。
一名55岁男性在7年前体检时发现双侧肺下叶有多个小结节。在过去3年的定期随访中，一些结节略有增大。由于结节大多为实性，患者接受了电视辅助胸腔镜下左下肺段切除术。术后病理诊断为BA。通过下一代测序（NGS）未检测到所有病变中的主要驱动基因融合和突变。随访37个月后未观察到复发或转移。值得注意的是，所有五个切除的病变均为BA/CMPT，其中一个病变伴有鳞状化生和肿瘤芽生。
我们的报告发现，伴有鳞状化生和肿瘤芽生的BA/CMPT有转化为肺鳞状细胞癌的潜力，扩大了其与恶性转化的关联。吸烟可能是危险因素之一。我们还发现BA/CMPT可以是多发病变而非单发病变。
