Sialadenoid Tumors of the Respiratory Tract
Radiologic—Pathologic Correlation
Tae Sung Kim1,
Kyung Soo Lee1,
Joungho Han2,
Eun A. Kim1,
Po Song Yang1 and
Jung-Gi Im3
1
Department of Radiology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
2
Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul 135-710, Korea.
3
Department of Radiology, Seoul National University College of Medicine, Yongon
Campus, Seoul 140-210, Korea.
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Fig. 1A. —36-year-old woman with adenoid cystic carcinoma. CT scan
obtained at level of lower neck shows diffuse circumferential wall thickening
(arrows) of proximal trachea.
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Fig. 1B. —36-year-old woman with adenoid cystic carcinoma.
Two-dimensional sagittal reformation of CT scan shows diffuse thickening
(arrows) of entire trachea.
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Fig. 1C. —36-year-old woman with adenoid cystic carcinoma.
Photomicrograph of biopsy specimen shows typical cribriform pattern with
islands of neoplastic epithelial cells containing several small round
pseudocystic structures. (H and E, x 100)
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Fig. 1D. —36-year-old woman with adenoid cystic carcinoma. CT scan
obtained 16 months later shows multiple metastatic nodules in both lungs, left
pleural space, and liver in addition to malignant pleural effusion.
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Fig. 2A. —62-year-old woman with adenoid cystic carcinoma.
Contrast-enhanced CT scan obtained at level of aortic arch shows diffuse and
eccentric wall thickening of trachea. Subtle irregularity on paramediastinal
lung represents radiation pneumonitis from previous radiation therapy.
Calcified right paratracheal lymph node is also incidentally noted.
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Fig. 2B. —62-year-old woman with adenoid cystic carcinoma.
Two-dimensional sagittal reformation of CT scan shows diffuse irregular wall
thickening with heaped-up margin (arrowheads) in trachea.
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Fig. 3A. —45-year-old man with adenoid cystic carcinoma. CT scan shows
soft-tissue mass (arrow) filling left main bronchus with bronchial
wall thickening, extending into left upper lobar bronchus.
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Fig. 3B. —45-year-old man with adenoid cystic carcinoma.
Photomicrograph of pneumonectomy specimen shows transmural solid mass with
intramural polypoid growth and destruction of bronchial cartilage. (H and E,
x1)
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Fig. 4A. —70-year-old man with mucoepidermoid carcinoma (high-grade
malignancy). Chest radiograph shows mass (arrowheads) in right
lateral wall of trachea, resulting in severe luminal narrowing of tracheal air
column.
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Fig. 4B. —70-year-old man with mucoepidermoid carcinoma (high-grade
malignancy). CT scan reveals polypoid mass in mid trachea, showing both
endophytic and exophytic growth.
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Fig. 4C. —70-year-old man with mucoepidermoid carcinoma (high-grade
malignancy). Photograph of gross specimen shows yellowish tan transmural
myxoid mass with destruction of bronchial cartilage.
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Fig. 5A. —36-year-old woman with mucoepidermoid carcinoma (high-grade
malignancy). Unenhanced CT scan obtained at level of aortic arch shows
polypoid mass in distal trachea.
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Fig. 5B. —36-year-old woman with mucoepidermoid carcinoma (high-grade
malignancy). Two-dimensional sagittal reformation of CT scan shows polypoid
endotracheal mass (arrowhead).
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Fig. 6A. —26-year-old woman with mucoepidermoid carcinoma (low-grade
malignancy). Posteroanterior chest radiograph shows complete combined
atelectasis of right middle and lower lobes.
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Fig. 6B. —26-year-old woman with mucoepidermoid carcinoma (low-grade
malignancy). Serial contrast-enhanced CT scans show mildly enhancing
endobronchial mass filling ectatic bronchus intermedius, resulting in complete
combined atelectasis of right middle, and lower lobes.
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Fig. 6C. —26-year-old woman with mucoepidermoid carcinoma (low-grade
malignancy). Serial contrast-enhanced CT scans show mildly enhancing
endobronchial mass filling ectatic bronchus intermedius, resulting in complete
combined atelectasis of right middle, and lower lobes.
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Fig. 6D. —26-year-old woman with mucoepidermoid carcinoma (low-grade
malignancy). Serial contrast-enhanced CT scans show mildly enhancing
endobronchial mass filling ectatic bronchus intermedius, resulting in complete
combined atelectasis of right middle, and lower lobes.
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Fig. 7A. —38-year-old woman with tracheal myoepithelioma.
Contrast-enhanced conventional (7-mm collimation) CT scan obtained at level of
lower neck shows 10 x 5 mm, well-defined nodule (arrow)
involving proximal tracheal wall and adjacent area.
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Fig. 7B. —38-year-old woman with tracheal myoepithelioma. Photograph of
sliced gross surgical specimen reveals well-circumscribed ovoid nodule with
broad base arising from tracheal ring. Most of tumor shows extratracheal
growth, although some intraluminal growth was noted (not shown). (H and E,
x4)
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Fig. 7C. —38-year-old woman with tracheal myoepithelioma.
Photomicrograph of biopsy specimen reveals spindle cell myoepithelioma, which
is predominantly composed of compactly arranged spindle cells. Some of spindle
cells show clear cytoplasmic change. (H and E, x100)
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Fig. 8A. —36-year-old man with recurrent myoepithelioma in left lower
lobe. Initial CT scan shows 35 x 25 mm subpleural mass in left lower
lobe.
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Fig. 8B. —36-year-old man with recurrent myoepithelioma in left lower
lobe. Follow-up unenhanced CT scan obtained 12 months after segmental
resection of tumor seen in A shows recurrent mass with minimal amount
of pleural effusion. Mass manifests as homogenous consolidation abutting
pleural surface, hence mimicking pleural-based mass.
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Fig. 8C. —36-year-old man with recurrent myoepithelioma in left lower
lobe. Photomicrograph of biopsy specimen obtained from partial resection of
left lower lobe reveals plasmacytoid myoepithelioma. Tumor is mainly composed
of round or ovoid cells with abundant eosinophilic hyaline cytoplasm and
eccentrically located nuclei. (H and E, x100)
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Fig. 8D. —36-year-old man with recurrent myoepithelioma in left lower
lobe. After second curative operation, large amount of multiloculated left
pleural and pericardial effusion was found on follow-up examination. Diffuse
and nodular pleural thickening (arrows) suggestive of pleural seeding
is seen on follow-up CT scan.
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Fig. 9A. —51-year-old woman with epithelial-myoepithelial carcinoma in
left lower lobe. Left decubitus chest radiograph shows air-space consolidation
or loculated subpulmonic effusion (arrows) in left lower lung
zone.
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Fig. 9B. —51-year-old woman with epithelial-myoepithelial carcinoma in
left lower lobe. Contrast-enhanced conventional (7-mm collimation) CT scan
obtained at level of liver dome shows segmental consolidation in left lower
lobe, mimicking pleural-based mass. Lesion shows slightly heterogeneous low
attenuation.
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Fig. 9C. —51-year-old woman with epithelial-myoepithelial carcinoma in
left lower lobe. Photomicrograph of biopsy specimen obtained from left lower
lobectomy shows epithelial—myoepithelial carcinoma of lung. Tumor is
composed of biphasic cell population: large polygonal myoepithelial cells in
peripheral location (arrow) and slightly cuboidal epithelial cells
forming lumen (arrowhead). Surrounding stromal tissue is hyalinized.
(H and E, x100)
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Fig. 9D. —51-year-old woman with epithelial-myoepithelial carcinoma in
left lower lobe. Photomicrograph of biopsy specimen with smooth muscle actin
immunostaining shows intense immunoreaction of peripherally located
myoepithelial cells in tubular formations. (smooth muscle actin
immunostaining, x100)
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Fig. 10A. —65-year-old woman with mucous gland adenoma.
Contrast-enhanced conventional (10-mm collimation) CT scan obtained at level
of aortic arch shows mildly enhancing mass in left upper lobe.
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Fig. 10B. —65-year-old woman with mucous gland adenoma. Lung-window CT
scan shows well-defined, ovoid mass with peripheral tiny radiolucencies, which
suggest residual lumen of segmental bronchus.
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