Diagnosis and malignant analysis of primary pulmonary mucinous adenocarcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FENG Yihui ¹ , ZHU Xiaolei ¹ , FANG Shaohan ² , ZHANG Xiaowen ^1,2 , LI Ning ^1,2 ,  GENG Guojun ¹

1. Fujian Medical University, Fuzhou, 350122, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, 360000, Fujian, P. R. China;

Corresponding author：

GENG Guojun, Email: ggj622@126.com

Keywords：

Primary pulmonary mucinous adenocarcinoma; mass type; pneumonia type; Ki-67 index; imaging characteristics; reversed halo-like sign

DOI：

10.7507/1007-4848.202303025

Video：

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Objective To investigate the relationship between primary pulmonary mucinous adenocarcinoma (PPMA) mass type and pneumonia type and the difference of malignant degree, and to analyze the role of clinical manifestations and CT features in the diagnosis of this disease. Methods The clinical data of PPMA patients admitted in the First Affiliated Hospital of Xiamen University from May 2011 to March 2022 were retrospectively analyzed. According to CT features, they were divided into a mass type group and a pneumonia type group. The clinical manifestations, CT features and the relationship between Ki-67 index and the degree of malignancy between the two groups were analyzed and compared, and the diagnostic ability of PPMA was enhanced. Results A total of 57 PPMA patients were enrolled. There were 17 males and 40 females, with an average age of 53.82±10.65 years, and 28 (49%) patients had reversed hato-like sign. There were statistically significant differences between the two groups in the maximum diameter of tumor, boundary condition and pleural indentation sign (P<0.05). There was no significant difference between the two groups in Ki-67% index and its high and low value-added groups (P>0.05). Conclusion There is no significant difference in the degree of malignancy between the two types of PPMA, which supports that the pneumonia type is only the manifestation of the disease progression of the lump type. PPMA is more common in elderly women and often occurs in both lower lungs. The clinical manifestations are mainly cough and white mucinous sputum. CT scans can show various manifestations, among which the reversed hato-like sign is expected to become an important imaging feature. Combined with high solid fraction, pleural indentation sign, and vacuole sign, it can play a significant auxiliary role in its diagnosis.

1.	Zhang, J, Chen, C, Zheng, H, et al. Clinicopathologic analysis of 57 cases of primary pulmonary mucinous adenocarcinoma. Zhonghua Zhong Liu Za Zhi, 2009, 31 (1): 66-68.
2.	Tian, P, Wang, Y, Wan, C, et al. CT-guided needle biopsy in the diagnosis of lung adenocarcinoma accompanied by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue: a rare combination. Int J Clin Exp Pathol, 2015, 8 (2): 2074-2078.
3.	Wang T, Yang Y, Liu X, et al. Primary invasive mucinous adenocarcinoma of the lung: Prognostic value of CT imaging features combined with clinical factors. Korean J Radiol, 2021, 22(4): 652-662.
4.	Nie K, Nie W, Zhang YX, et al. Comparing clinicopathological features and prognosis of primary pulmonary invasive mucinous adenocarcinoma based on computed tomography findings. Cancer Imaging, 2019, 19(1): 47.
5.	刘连荣, 邢志珩, 张雪君. 原发性肺黏液腺癌的影像学表现及病理基础. 临床放射学杂志, 2022, 41(9): 1788-1791.
6.	Nie K, Nie W, Zhang YX, et al. Comparing clinicopathological features and prognosis of primary pulmonary invasive mucinous adenocarcinoma based on computed tomography findings. Cancer Imaging, 2019, 19(1): 47.
7.	Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
8.	Ibrahim T, Farolfi A, Scarpi E, et al . Hormonal receptor, human epidermal growth factor receptor-2, and Ki67 discordance between primary breast cancer and paired metastases: Clinical impact. Oncology, 2013, 84(3): 150-157.
9.	Chlebowski RT, Col N, Winer EP, et al . American Society of Clinical Oncology technology assessment of pharmacologic interventions for breast cancer risk reduction including tamoxifen, raloxifene, and aromatase inhibition. J Clin Oncol, 2002, 20(15): 3328-3343.
10.	Fu Q, Liu SL, Hao DP, et al . CT Radiomics model for predicting the Ki-67 index of lung cancer: An exploratory study. Front Oncol, 2021, 11: 743490.
11.	英天舒, 张晓晔. 31例原发性肺黏液腺癌的CT表现与病理特点分析. 实用癌症杂志, 2016, 31(4): 567-568, 571.
12.	包杰, 金银华, 华奇峰等. 结合病理对原发性肺粘液腺癌的MSCT表现分析. 医学影像学杂志, 2020, 30(5): 871-874.
13.	Watanabe H, Saito H, Yokose T, et al . Relation between thin-section computed tomography and clinical findings of mucinous adenocarcinoma. Ann Thorac Surg, 2015, 99(3): 975-981.
14.	Lee HY, Cha MJ, Lee KS, et al . Prognosis in resected invasive mucinous adenocarcinomas of the lung: Related factors and comparison with resected nonmucinous adenocarcinomas. J Thorac Oncol, 2016, 11(7): 1064-1073.
15.	段劲松, 杨金伟, 刘立陶等. 肺腺癌实性成分CT影像与病理特征的相关性分析. 现代肿瘤医学, 2022, 30(23): 4338-4343.
16.	Oda S, Awai K, Liu D, et al . Ground-glass opacities on thin-section helical CT: differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. AJR Am J Roentgenol, 2008, 190(5): 1363-1368.
17.	任华, 李惠民, 虞崚崴等. 表现为反晕征的肺磨玻璃结节CT诊断. 中国医学计算机成像杂志, 2018, 24(2): 127-131.
18.	童永秀, 张彩霞, 张玮等. 反晕征在不同肺部疾病中的特征. 中国医学影像学杂志, 2020, 28(5): 353-356.
19.	Bourcier J, Heudes PM, Morio F, et al . Prevalence of the reversed halo sign in neutropenic patients compared with non-neutropenic patients: Data from a single-centre study involving 27 patients with pulmonary mucormycosis (2003-2016). Mycoses, 2017, 60(8): 526-533.
20.	Warth A, Cortis J, Soltermann A, et al . Tumour cell proliferation (Ki-67) in non-small cell lung cancer: A critical reappraisal of its prognostic role. Br J Cancer, 2014, 111(6): 1222-1229.
21.	Masuda D, Masuda R, Matsuzaki T, et al . Ki-67 labeling index affects tumor infiltration patterns of lung squamous cell carcinoma. Mol Med Rep, 2015, 12(5): 7303-7309.
22.	Yu JQ, Zhou Q, Zheng YF, et al . Expression of vimentin and Ki-67 proteins in cervical squamous cell carcinoma and their relationships with clinicopathological features. Asian Pac J Cancer Prev, 2015, 16(10): 4271-4275.
23.	Gioacchini FM, Alicandri-Ciufelli M, Magliulo G, et al . The clinical relevance of Ki-67 expression in laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol, 2015, 272(7): 1569-1576.
24.	Yin Y, Zeng K, Wu M, et al . The levels of Ki-67 positive are positively associated with lymph node metastasis in invasive ductal breast cancer. Cell Biochem Biophys, 2014, 70(2): 1145-1151.
25.	Çalik M, Demirci E, Altun E, et al . Clinicopathological importance of Ki-67, p27, and p53 expression in gastric cancer. Turk J Med Sci, 2015, 45(1): 118-128.
26.	Tang J, Gui C, Qiu S, et al . The clinicopathological significance of Ki67 in papillary thyroid carcinoma: a suitable indicator?. World J Surg Oncol, 2018, 16(1): 100.
27.	Jemal A, Ma J, Rosenberg PS, et al . Increasing lung cancer death rates among young women in southern and midwestern States. J Clin Oncol, 2012, 30(22): 2739-2744.

1. Zhang, J, Chen, C, Zheng, H, et al. Clinicopathologic analysis of 57 cases of primary pulmonary mucinous adenocarcinoma. Zhonghua Zhong Liu Za Zhi, 2009, 31 (1): 66-68.
2. Tian, P, Wang, Y, Wan, C, et al. CT-guided needle biopsy in the diagnosis of lung adenocarcinoma accompanied by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue: a rare combination. Int J Clin Exp Pathol, 2015, 8 (2): 2074-2078.
3. Wang T, Yang Y, Liu X, et al. Primary invasive mucinous adenocarcinoma of the lung: Prognostic value of CT imaging features combined with clinical factors. Korean J Radiol, 2021, 22(4): 652-662.
4. Nie K, Nie W, Zhang YX, et al. Comparing clinicopathological features and prognosis of primary pulmonary invasive mucinous adenocarcinoma based on computed tomography findings. Cancer Imaging, 2019, 19(1): 47.
5. 刘连荣, 邢志珩, 张雪君. 原发性肺黏液腺癌的影像学表现及病理基础. 临床放射学杂志, 2022, 41(9): 1788-1791.
6. Nie K, Nie W, Zhang YX, et al. Comparing clinicopathological features and prognosis of primary pulmonary invasive mucinous adenocarcinoma based on computed tomography findings. Cancer Imaging, 2019, 19(1): 47.
7. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology, 2008, 246(3): 697-722.
8. Ibrahim T, Farolfi A, Scarpi E, et al . Hormonal receptor, human epidermal growth factor receptor-2, and Ki67 discordance between primary breast cancer and paired metastases: Clinical impact. Oncology, 2013, 84(3): 150-157.
9. Chlebowski RT, Col N, Winer EP, et al . American Society of Clinical Oncology technology assessment of pharmacologic interventions for breast cancer risk reduction including tamoxifen, raloxifene, and aromatase inhibition. J Clin Oncol, 2002, 20(15): 3328-3343.
10. Fu Q, Liu SL, Hao DP, et al . CT Radiomics model for predicting the Ki-67 index of lung cancer: An exploratory study. Front Oncol, 2021, 11: 743490.
11. 英天舒, 张晓晔. 31例原发性肺黏液腺癌的CT表现与病理特点分析. 实用癌症杂志, 2016, 31(4): 567-568, 571.
12. 包杰, 金银华, 华奇峰等. 结合病理对原发性肺粘液腺癌的MSCT表现分析. 医学影像学杂志, 2020, 30(5): 871-874.
13. Watanabe H, Saito H, Yokose T, et al . Relation between thin-section computed tomography and clinical findings of mucinous adenocarcinoma. Ann Thorac Surg, 2015, 99(3): 975-981.
14. Lee HY, Cha MJ, Lee KS, et al . Prognosis in resected invasive mucinous adenocarcinomas of the lung: Related factors and comparison with resected nonmucinous adenocarcinomas. J Thorac Oncol, 2016, 11(7): 1064-1073.
15. 段劲松, 杨金伟, 刘立陶等. 肺腺癌实性成分CT影像与病理特征的相关性分析. 现代肿瘤医学, 2022, 30(23): 4338-4343.
16. Oda S, Awai K, Liu D, et al . Ground-glass opacities on thin-section helical CT: differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. AJR Am J Roentgenol, 2008, 190(5): 1363-1368.
17. 任华, 李惠民, 虞崚崴等. 表现为反晕征的肺磨玻璃结节CT诊断. 中国医学计算机成像杂志, 2018, 24(2): 127-131.
18. 童永秀, 张彩霞, 张玮等. 反晕征在不同肺部疾病中的特征. 中国医学影像学杂志, 2020, 28(5): 353-356.
19. Bourcier J, Heudes PM, Morio F, et al . Prevalence of the reversed halo sign in neutropenic patients compared with non-neutropenic patients: Data from a single-centre study involving 27 patients with pulmonary mucormycosis (2003-2016). Mycoses, 2017, 60(8): 526-533.
20. Warth A, Cortis J, Soltermann A, et al . Tumour cell proliferation (Ki-67) in non-small cell lung cancer: A critical reappraisal of its prognostic role. Br J Cancer, 2014, 111(6): 1222-1229.
21. Masuda D, Masuda R, Matsuzaki T, et al . Ki-67 labeling index affects tumor infiltration patterns of lung squamous cell carcinoma. Mol Med Rep, 2015, 12(5): 7303-7309.
22. Yu JQ, Zhou Q, Zheng YF, et al . Expression of vimentin and Ki-67 proteins in cervical squamous cell carcinoma and their relationships with clinicopathological features. Asian Pac J Cancer Prev, 2015, 16(10): 4271-4275.
23. Gioacchini FM, Alicandri-Ciufelli M, Magliulo G, et al . The clinical relevance of Ki-67 expression in laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol, 2015, 272(7): 1569-1576.
24. Yin Y, Zeng K, Wu M, et al . The levels of Ki-67 positive are positively associated with lymph node metastasis in invasive ductal breast cancer. Cell Biochem Biophys, 2014, 70(2): 1145-1151.
25. Çalik M, Demirci E, Altun E, et al . Clinicopathological importance of Ki-67, p27, and p53 expression in gastric cancer. Turk J Med Sci, 2015, 45(1): 118-128.
26. Tang J, Gui C, Qiu S, et al . The clinicopathological significance of Ki67 in papillary thyroid carcinoma: a suitable indicator?. World J Surg Oncol, 2018, 16(1): 100.
27. Jemal A, Ma J, Rosenberg PS, et al . Increasing lung cancer death rates among young women in southern and midwestern States. J Clin Oncol, 2012, 30(22): 2739-2744.

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