[Errors and difficulties in diagnosing bronchiolar adenoma]

Area of Science:

• Pulmonology
• Surgical Pathology
• Oncology

Background:

• Ciliated muconodular papillary tumor (CMPTs), or bronchiolar adenomas, are rare lung neoplasms.
• Distinguishing CMPTs from adenocarcinoma poses diagnostic challenges, particularly preoperatively and intraoperatively.
• Bilateral lung lesions requiring surgical intervention for CMPT are exceptionally uncommon.

Purpose of the Study:

• To present a rare clinical case of bilateral CMPT/bronchiolar adenoma.
• To discuss the diagnostic difficulties in differentiating CMPTs from adenocarcinoma.
• To illustrate the utility of multislice computed tomography, histology, immunohistochemistry, and molecular genetics in diagnosing CMPTs.

Main Methods:

• Surgical resection of bilateral lung lesions.
• Histopathological examination of resected tissue.
• Immunohistochemical staining for diagnostic markers.
• Multislice computed tomography (MSCT) imaging.
• Molecular genetic analysis.

Main Results:

• The patient was diagnosed with a ciliated muconodular papillary tumor/bronchiolar adenoma.
• Differential diagnosis challenges with adenocarcinoma were highlighted during pre- and intraoperative assessments.
• Histological and immunohistochemical features of both proximal and distal bronchiolar adenoma types were detailed.
• Molecular genetic findings for bronchiolar adenoma were presented and compared with existing literature.

Conclusions:

• Accurate diagnosis of bronchiolar adenoma requires a combination of advanced imaging, detailed histopathology, specific immunohistochemistry, and molecular analysis.
• CMPTs present unique diagnostic challenges that necessitate careful evaluation to differentiate them from malignant lung neoplasms like adenocarcinoma.
• This case underscores the importance of comprehensive diagnostic approaches for rare lung tumors.