Primary Paget-like intraepithelial glandular lesion of the bronchus: report of a first case.
Source: PubMed, NCBI / U.S. National Library of Medicine
To report and describe a first case of primary Paget-like intraepithelial glandular lesion of the bronchus in an 83-year-old White man undergoing a right lower lobe segmentectomy for a primary squamous cell carcinoma (SCC). The focus of the bronchial primary Paget-like intraepithelial glandular lesion was discovered incidentally, and the diagnosis was confirmed by detailed histologic examination, immunohistochemical studies, and targeted genetic sequencing. Detailed review of clinical history and pertinent radiology was also undertaken to exclude metastasis from another site. Atypical glandular cells were identified within the epithelium of a subsegmental bronchus examined, at a distance from the primary SCC. The lesional cells were positive for CK7, GATA3, m-CEA, and mucicarmine; were weakly positive for ER and PR; and showed 2+ membrane staining for HER2. They were cytologically different from the SCC and negative for p40 and CK5/6. There was no history of breast carcinoma and no suspicious lesions within mammary tissue on preoperative imaging. The patient has no evidence of recurrence or new intra- or extrathoracic lesions at 18 months postsurgery. We report the first case of primary Paget-like intraepithelial glandular neoplasia originating in the bronchial epithelium. While the clinical significance of this unusual finding is unknown, it challenges the existing hypotheses concerning the cellular origin of extramammary Paget disease, which include Toker cell
Abstract
To report and describe a first case of primary Paget-like intraepithelial glandular lesion of the bronchus in an 83-year-old White man undergoing a right lower lobe segmentectomy for a primary squamous cell carcinoma (SCC). The focus of the bronchial primary Paget-like intraepithelial glandular lesion was discovered incidentally, and the diagnosis was confirmed by detailed histologic examination, immunohistochemical studies, and targeted genetic sequencing. Detailed review of clinical history and pertinent radiology was also undertaken to exclude metastasis from another site. Atypical glandular cells were identified within the epithelium of a subsegmental bronchus examined, at a distance from the primary SCC. The lesional cells were positive for CK7, GATA3, m-CEA, and mucicarmine; were weakly positive for ER and PR; and showed 2+ membrane staining for HER2. They were cytologically different from the SCC and negative for p40 and CK5/6. There was no history of breast carcinoma and no suspicious lesions within mammary tissue on preoperative imaging. The patient has no evidence of recurrence or new intra- or extrathoracic lesions at 18 months postsurgery. We report the first case of primary Paget-like intraepithelial glandular neoplasia originating in the bronchial epithelium. While the clinical significance of this unusual finding is unknown, it challenges the existing hypotheses concerning the cellular origin of extramammary Paget disease, which include Toker cells, pluripotent keratinocyte stem cells, and apocrine gland ducts, none of which are native to the bronchial epithelium.